Healthcare Provider Details

I. General information

NPI: 1578102984
Provider Name (Legal Business Name): SAGE PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 2ND ST W STE 20
WHITEFISH MT
59937-3036
US

IV. Provider business mailing address

453 DAKOTA AVE
WHITEFISH MT
59937-2102
US

V. Phone/Fax

Practice location:
  • Phone: 406-318-7775
  • Fax:
Mailing address:
  • Phone: 732-310-8583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAREN LENARD
Title or Position: OWNER
Credential: PSY.D.
Phone: 732-310-8583