Polk Youth Services, Inc.

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

0243 Issued in OR

Legal business name

POLK YOUTH SERVICES, INC.

Practice address

175 NE Kings Valley Hwy Ste a
Dallas, OR 97338-1787

Phone

(503) 623-3310

NPI assigned

Jan 14, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David James Valencia, MS

Title

Executive Director/President

Phone

(503) 623-3310

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1452729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452729600000",
    "number": "1427414895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 NE KINGS VALLEY HWY STE A",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973381787",
            "telephone_number": "503-623-3310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 NE KINGS VALLEY HWY STE A",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973381787",
            "telephone_number": "503-623-3310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLK YOUTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-14",
        "last_updated": "2016-01-14",
        "status": "A",
        "authorized_official_last_name": "VALENCIA",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR/PRESIDENT",
        "authorized_official_telephone_number": "503-623-3310",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "OR",
            "license": "0243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Polk County Mental Health
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• Polk Vision Clinics Inc.
• Jason Dean Pool, MSW
• Sara Joy Porter, LMT
• Lyndsay Marie Posey, L.AC.
• Praxis Health, PC
• Prestigious Corporation

• Emotionally Disturbed Childrens' Residential Treatment Facility in Dallas, OR
• Providers in Dallas, OR by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.