Healthcare Provider Details

I. General information

NPI: 1306697537
Provider Name (Legal Business Name): TAYLOR SAGE CHARLES LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAGE CHARLES

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 FREDERICK ST STE 103
SANTA CRUZ CA
95062-2239
US

IV. Provider business mailing address

64 BELCHER ST
SAN FRANCISCO CA
94114-1108
US

V. Phone/Fax

Practice location:
  • Phone: 831-996-1222
  • Fax:
Mailing address:
  • Phone: 818-426-9970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT164154
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: