Healthcare Provider Details

I. General information

NPI: 1851114599
Provider Name (Legal Business Name): SAGEBERRY PSYCHOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E MAIN ST STE E
NEW ALBANY MS
38652-3913
US

IV. Provider business mailing address

104 E MAIN ST STE E
NEW ALBANY MS
38652-3913
US

V. Phone/Fax

Practice location:
  • Phone: 662-205-0464
  • Fax:
Mailing address:
  • Phone: 662-205-0464
  • Fax: 662-350-7107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MEAGAN MEDLEY
Title or Position: OWNER, PSYCHOLOGIST
Credential: LP
Phone: 662-205-0464