Provider Demographics
NPI:1134701667
Name:BORD, SARAH ROSE (LPC, CADC I)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ROSE
Last Name:BORD
Suffix:
Gender:F
Credentials:LPC, CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16409 SE DIVISION ST.
Mailing Address - Street 2:STE 216 PMB 1024
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236
Mailing Address - Country:US
Mailing Address - Phone:971-253-0676
Mailing Address - Fax:855-978-2053
Practice Address - Street 1:10107 SE TIBBETTS CT
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1277
Practice Address - Country:US
Practice Address - Phone:832-567-8241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR5613101YM0800X
ORC6365101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health