Provider Demographics
NPI:1699133348
Name:SARAH WILSON COUNSELING
Entity type:Organization
Organization Name:SARAH WILSON COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHILD, ADULT AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:503-729-2920
Mailing Address - Street 1:1135 SOUTHEAST SALMON STREET
Mailing Address - Street 2:UNIT 101
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214
Mailing Address - Country:US
Mailing Address - Phone:503-729-2920
Mailing Address - Fax:
Practice Address - Street 1:1135 SE SALMON ST
Practice Address - Street 2:UNIT 101
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3375
Practice Address - Country:US
Practice Address - Phone:503-729-2920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3951261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC3951OtherLPC