Individual
CHARLES KEITH SANBORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
357 NE COURT ST, PRINEVILLE, OR 97754-1936
(541) 504-7535
(541) 504-7535
Mailing address
357 NE COURT ST, PRINEVILLE, OR 97754-1936
(541) 504-7535
(541) 504-7535
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
500654390
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500654390
—
OR
Enumeration date
05/08/2019
Last updated
05/08/2019
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