Healthcare Provider Details

I. General information

NPI: 1720961030
Provider Name (Legal Business Name): KAGE JONUS SAGAN LMHC GRAD STUDENT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2025
Last Update Date: 07/26/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 GRANBY RD
CHICOPEE MA
01020-1568
US

IV. Provider business mailing address

21 REYNOLDS AVE
MONSON MA
01057-1412
US

V. Phone/Fax

Practice location:
  • Phone: 833-243-8255
  • Fax:
Mailing address:
  • Phone: 413-668-4597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: