Healthcare Provider Details

I. General information

NPI: 1174411268
Provider Name (Legal Business Name): SAGE INDIVIDUAL AND MARRIAGE COUNSELING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31181 OLD RIVER RD
BONSALL CA
92003-5104
US

IV. Provider business mailing address

31181 OLD RIVER RD
BONSALL CA
92003-5104
US

V. Phone/Fax

Practice location:
  • Phone: 760-809-3347
  • Fax:
Mailing address:
  • Phone: 760-809-3347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: EMILY EYERLY
Title or Position: OWNER
Credential: LMFT
Phone: 760-809-3347