=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790206837
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SARABETH CASEY COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2017
-----------------------------------------------------
Last Update Date | 02/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8555 SW APPLE WAY
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97225-1774
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-869-3813
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8555 SW APPLE WAY STE 320
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97225-1775
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-869-3813
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHILD AND FAMILY THERAPIST
-----------------------------------------------------
Name | SARA ELIZABETH CASEY
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 503-869-3813
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number | C2350
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------