Healthcare Provider Details

I. General information

NPI: 1134945280
Provider Name (Legal Business Name): SAGE COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S 8TH AVE
BRANDON SD
57005-1772
US

IV. Provider business mailing address

700 S 8TH AVE
BRANDON SD
57005-1772
US

V. Phone/Fax

Practice location:
  • Phone: 605-582-4722
  • Fax:
Mailing address:
  • Phone: 605-582-4722
  • 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 TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ERICA GLOOR
Title or Position: OWNER/THERAPIST
Credential: LPCMH, LAC
Phone: 605-582-4722