=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851114599
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAGEBERRY PSYCHOLOGY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2024
-----------------------------------------------------
Last Update Date | 01/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 E MAIN ST STE E
-----------------------------------------------------
City | NEW ALBANY
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38652-3913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-205-0464
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 104 E MAIN ST STE E
-----------------------------------------------------
City | NEW ALBANY
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38652-3913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-205-0464
-----------------------------------------------------
Fax | 662-350-7107
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, PSYCHOLOGIST
-----------------------------------------------------
Name | DR. MEAGAN MEDLEY
-----------------------------------------------------
Credential | LP
-----------------------------------------------------
Telephone | 662-205-0464
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------