Healthcare Provider Details

I. General information

NPI: 1174437289
Provider Name (Legal Business Name): SAND AND SAGE MARRIAGE AND FAMILY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6030 VILLA MEDICI
BONSALL CA
92003-6222
US

IV. Provider business mailing address

6030 VILLA MEDICI
BONSALL CA
92003-6222
US

V. Phone/Fax

Practice location:
  • Phone: 559-817-2400
  • Fax:
Mailing address:
  • Phone: 559-817-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRANDON STEPHEN BERGLUND
Title or Position: PRESIDENT
Credential: LMFT
Phone: 559-817-2400