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General NPI Number Information
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NPI Number | 1558049155
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Entity Type | Organization
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Legal Business Name | SAGE AND PINE COUNSELING, LLC
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Dates
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Enumeration Date | 07/05/2023
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 1042 W MILL AVE STE 103
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2489
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Country | US
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Telephone | 208-405-0260
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Fax |
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Provider Business Mailing Address
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Address Line | 1042 W MILL AVE STE 103
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2489
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Country | US
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Telephone | 208-405-0260
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Fax |
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Authorized Official
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Title or Position | OWNER AND PRACTITIONER
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Name | KARISSA KIMES
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Credential | LAMFT
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Telephone | 208-699-3667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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