Provider Demographics
NPI:1285039917
Name:STUBBS, SANDRA GALE (LPC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:GALE
Last Name:STUBBS
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 1:10260 SW GREENBURG RD STE 400
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5514
Mailing Address - Country:US
Mailing Address - Phone:971-264-0649
Mailing Address - Fax:541-320-9053
Practice Address - Street 1:10260 SW GREENBURG RD STE 400
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5514
Practice Address - Country:US
Practice Address - Phone:971-264-0649
Practice Address - Fax:541-320-9053
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4441101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500679772Medicaid
OR464755148Medicaid