Individual ProviderStacy L YoungCounselorBehavioral Health & Social Service ProvidersPractice Address10373 NE Hancock St Ste 220, Portland, OR 97220-3873(503) 490-9288PECOS EnrollmentBased on the most recent information from CMS, provider Stacy L Young does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1215068523Provider TypeIndividualFull NameYoung, Stacy LCredentialL.C.S.W.GenderFemaleSole ProprietorYesEnumeration Date3/8/2007Last Updated7/8/2007Contact InformationPractice LocationPractice Address10373 NE Hancock St Ste 220, Portland, OR 97220-3873Phone(503) 490-9288Fax(503) 762-0536Mailing LocationMailing AddressPO Box 66553, Portland, OR 97290-6553Phone(503) 490-9288Fax(503) 762-0536Provider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseL2708Oregon