Provider Demographics
NPI:1508298571
Name:HAYDEN, SARA (MA, LPC (ID))
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:HAYDEN
Suffix:
Gender:F
Credentials:MA, LPC (ID)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX V
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-0076
Mailing Address - Country:US
Mailing Address - Phone:541-889-1050
Mailing Address - Fax:541-889-6524
Practice Address - Street 1:390 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2513
Practice Address - Country:US
Practice Address - Phone:541-889-1050
Practice Address - Fax:541-889-6524
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4562101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health