Provider Demographics
NPI:1770706954
Name:STARK, SARA CALLENDER (PHD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:CALLENDER
Last Name:STARK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32386 WILSON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-9272
Mailing Address - Country:US
Mailing Address - Phone:707-972-8826
Mailing Address - Fax:360-844-5184
Practice Address - Street 1:115 W 8TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2997
Practice Address - Country:US
Practice Address - Phone:079-728-8267
Practice Address - Fax:360-844-5184
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15377103T00000X
OR3145103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical