=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194506436
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE SAGE COUCH COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2023
-----------------------------------------------------
Last Update Date | 10/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1247 WASHINGTON RD STE 20
-----------------------------------------------------
City | RYE
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03870-2345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-787-5759
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1247 WASHINGTON RD STE 20
-----------------------------------------------------
City | RYE
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03870-2345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARTA ROBINSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 603-682-2264
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------