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General NPI Number Information
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NPI Number | 1487424750
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Entity Type | Organization
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Legal Business Name | SAGE OWL THERAPY SERVICES, PLLC
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Dates
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Enumeration Date | 01/08/2024
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 27975 ALYCEKAY ST
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-3823
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Country | US
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Telephone | 482-445-3151
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Fax |
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Provider Business Mailing Address
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Address Line | 625 KENMOOR AVE SE STE 350 PMB 909073
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2395
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Country | US
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Telephone | 248-445-3151
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MONIQUE NASH
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Credential | TLLP
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Telephone | 248-445-3151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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