Sandra Rustam, M.A., LPCI

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Practice address

3601 SW Murray Blvd
Suite 300
Beaverton, OR 97005-2354

Phone

(503) 730-1790

NPI assigned

Sep 18, 2007

Reactivated

Nov 17, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 7

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480032000000",
    "number": "1285820704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14745 SW SANDHILL LOOP",
            "address_2": "SUITE 204",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970079079",
            "telephone_number": "503-730-1790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 SW MURRAY BLVD",
            "address_2": "SUITE 300",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970052354",
            "telephone_number": "503-730-1790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSTAM",
        "first_name": "SANDRA",
        "credential": "M.A., LPCI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-09-18",
        "last_updated": "2016-11-25",
        "deactivation_date": "2013-07-29",
        "reactivation_date": "2016-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Austin Ruiz
• Nayeli Ruiz
• McKenzie Carol Rushcamp, SLP
• Carrie Elizabeth Russo, NTP
• Brian Tyson Rust, DMD
• Melissa Rutherford
• Julie Ruud
• Elizabeth Dawne Ruzi
• Daniel Richard Ryan, DPT
• Erica Ryan

• Professional Counselor in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.