Healthcare Provider Details

I. General information

NPI: 1467022392
Provider Name (Legal Business Name): SAGACITY COUNSELING AND NEUROTHERAPEUTIC SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7902 FERN MOUNTAIN RD
MUSKOGEE OK
74401-7207
US

IV. Provider business mailing address

915 DENISON ST
MUSKOGEE OK
74401-5932
US

V. Phone/Fax

Practice location:
  • Phone: 479-276-8871
  • Fax:
Mailing address:
  • Phone: 479-276-8871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: LEONARD SAUNDERS SSHEPHERD
Title or Position: PRESIDENT
Credential: M.S. LPC
Phone: 918-609-2878