Healthcare Provider Details

I. General information

NPI: 1750217402
Provider Name (Legal Business Name): SAGE MEADOWS MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 W BROADWAY STE 700
SALT LAKE CITY UT
84101-2060
US

IV. Provider business mailing address

9212 FOX RUN AVE
BATON ROUGE LA
70808-8107
US

V. Phone/Fax

Practice location:
  • Phone: 801-876-5634
  • Fax: 801-907-7323
Mailing address:
  • Phone: 225-276-0144
  • Fax: 801-907-7323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ERICA CHUSTZ
Title or Position: OWNER/ PROVIDER
Credential: PA-C
Phone: 801-876-5634