Healthcare Provider Details

I. General information

NPI: 1326958299
Provider Name (Legal Business Name): SAGENT BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 CENTRE POINTE DR
MENDOTA HEIGHTS MN
55120-1276
US

IV. Provider business mailing address

1155 CENTRE POINTE DR
MENDOTA HEIGHTS MN
55120-1276
US

V. Phone/Fax

Practice location:
  • Phone: 651-461-8033
  • Fax: 651-461-8034
Mailing address:
  • Phone: 651-461-8033
  • Fax: 651-461-8034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: TAYLOR DAWN BOHANNON
Title or Position: OCCUPATIONAL THERAPY STUDENT
Credential: OTS
Phone: 309-236-8874