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General NPI Number Information
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NPI Number | 1033587241
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Entity Type | Individual
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Provider Name | SARAH PROBST M.A., LPCI
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Gender | Female
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Dates
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Enumeration Date | 09/03/2015
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Last Update Date | 12/09/2016
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Provider Practice Location Address
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Address Line | 4036 NE SANDY BLVD SUITE 203
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City | PORTLAND
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State | OR
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Zip | 97212-5335
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Country | US
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Telephone | 503-619-6994
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Fax |
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Provider Business Mailing Address
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Address Line | 10225 NE HOLLADAY ST
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City | PORTLAND
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State | OR
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Zip | 97220-3920
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Country | US
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Telephone | 503-619-6994
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | R3797
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C4343
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License Number State | OR
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