Individual
SARA A KOYANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHP-R, CADC-R
Contact information
Practice address
3099 NE DIAMOND LAKE BLVD, ROSEBURG, OR 97470-3655
(541) 673-3469
Mailing address
PO BOX 1121, ROSEBURG, OR 97470-0254
(541) 492-4550
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-21-1068
OR
101YM0800X
Mental Health Counselor
20-QMHP-R-0193
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500776784
—
OR
Enumeration date
02/18/2020
Last updated
03/13/2023
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