Provider Demographics
NPI:1518498567
Name:SIRSTAD, AMBER (LPC)
Entity type:Individual
Prefix:MS
First Name:AMBER
Middle Name:
Last Name:SIRSTAD
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 1:39337 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-5344
Mailing Address - Country:US
Mailing Address - Phone:503-550-9406
Mailing Address - Fax:
Practice Address - Street 1:9123 SE SAINT HELENS ST STE 270E
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-6801
Practice Address - Country:US
Practice Address - Phone:503-550-9406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5771101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health