Provider Demographics
NPI:1104681089
Name:DYKES, SARAH ZENITH (LPC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ZENITH
Last Name:DYKES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 NE 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-6911
Mailing Address - Country:US
Mailing Address - Phone:503-803-8752
Mailing Address - Fax:
Practice Address - Street 1:1906 SW MADISON ST STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1760
Practice Address - Country:US
Practice Address - Phone:541-223-9277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC7590101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health