Active NPI
Sara A Koyano, QMHP-C, CADC-I
- Addiction (Substance Use Disorder) Counselor
- Gresham, OR
National Provider Identifier
1336772417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 23-07-10817
- Practice address
- 620 NE 2ND St
Gresham, OR 97030-7514 - Phone
- (971) 274-3757
- Fax
- (503) 912-5740
- NPI assigned
- Feb 18, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 23-07-10817 | OR | Primary |
| Mental Health Counselor | 101YM0800X | 22-QMHPC-001136 | OR |
Addresses
Primary practice location
620 NE 2ND St
Gresham, OR 97030-7514
Mailing address
211 SE Caruthers St
Portland, OR 97214-4502
Phone (971) 217-9008
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500776784 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T-21-1068 | OR | MD | Addiction (Substance Use Disorder) Counselor |
| 20-QMHP-R-0193 | OR | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Serenity Lane | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Substance Abuse Rehabilitation Facility
- Coburg, OR
- NPI 1467283069
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1581984000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785888000000",
"number": "1336772417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "211 SE CARUTHERS ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972144502",
"telephone_number": "971-217-9008",
"fax_number": "971-260-0355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 NE 2ND ST",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970307514",
"telephone_number": "971-274-3757",
"fax_number": "503-912-5740"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOYANO",
"first_name": "SARA",
"middle_name": "A",
"credential": "QMHP-C, CADC-I",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-02-18",
"last_updated": "2026-08-05",
"certification_date": "2026-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OR",
"license": "23-07-10817",
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "22-QMHPC-001136",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500776784",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Gresham, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.