Provider Demographics
NPI:1053297788
Name:BROADHEAD, SARAH (MFT-A)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BROADHEAD
Suffix:
Gender:F
Credentials:MFT-A
Other - Prefix:
Other - First Name:SUNNY
Other - Middle Name:
Other - Last Name:BROADHEAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10606 SW 49TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-6802
Mailing Address - Country:US
Mailing Address - Phone:253-324-5057
Mailing Address - Fax:
Practice Address - Street 1:2923 NE BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1760
Practice Address - Country:US
Practice Address - Phone:503-208-5566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR11622106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty