Provider Demographics
NPI:1255060414
Name:BINGHAM, SARAH (MCOUN)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:MCOUN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 TYLERS PL
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97351-1340
Mailing Address - Country:US
Mailing Address - Phone:503-888-6413
Mailing Address - Fax:
Practice Address - Street 1:200 HAWTHORNE AVE SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-5860
Practice Address - Country:US
Practice Address - Phone:541-900-4285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-05
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR6420101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional