Provider Demographics
NPI:1568132496
Name:COLLEEN SARA LLC
Entity Type:Organization
Organization Name:COLLEEN SARA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:SARA
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:PCA, MA, NCC
Authorized Official - Phone:503-609-0615
Mailing Address - Street 1:4910 SE 28TH AVE APT 267
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-9413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4910 SE 28TH AVE APT 267
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-9413
Practice Address - Country:US
Practice Address - Phone:503-609-0615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty