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General NPI Number Information
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NPI Number | 1427613025
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Entity Type | Organization
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Legal Business Name | SAGEWISE COUNSELING, LLC
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Dates
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Enumeration Date | 05/08/2019
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Last Update Date | 05/08/2019
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Provider Practice Location Address
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Address Line | 404 WHISPERING PINE DR
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City | TWIN FALLS
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State | ID
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Zip | 83301-8933
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Country | US
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Telephone | 208-736-1726
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Fax | 208-944-9382
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Provider Business Mailing Address
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Address Line | 404 WHISPERING PINE DR
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City | TWIN FALLS
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State | ID
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Zip | 83301-8933
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Country | US
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Telephone | 208-736-1726
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Fax | 208-944-9382
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Authorized Official
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Title or Position | CLINICIAN
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Name | CURTIS JOHNSON
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Credential | LCSW
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Telephone | 208-736-1726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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