Provider Demographics
NPI:1649685009
Name:SANDY COUNSELING CENTER LLP
Entity type:Organization
Organization Name:SANDY COUNSELING CENTER LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALTON
Authorized Official - Middle Name:RICHARDSON
Authorized Official - Last Name:ROUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CADC III
Authorized Official - Phone:503-826-8500
Mailing Address - Street 1:39084 PROCTOR BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-8064
Mailing Address - Country:US
Mailing Address - Phone:503-826-8500
Mailing Address - Fax:413-215-5103
Practice Address - Street 1:39084 PROCTOR BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-8064
Practice Address - Country:US
Practice Address - Phone:503-826-8500
Practice Address - Fax:413-215-5103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR96-10-67101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty