Organization Name: | SAGE SERVICES LLC |
NPI Number: | 1093182826 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CARRIE G MASTRONARDE (OWNER) |
Mailing Address: | 340 N Chamber Dr Fredericktown |
State: | MO US |
Postal Code: | 636457947 |
Phone Number: | 5735173951 |
Fax Number: | 8665170663 |
NPI Enumeration Date: | 08/27/2015 |
NPI Last Update Date: | 08/27/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2006009196 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |