MEDICARE: SAGELY COUNSELING AND COACHING, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1023971876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAGELY COUNSELING AND COACHING, PLLC

Provider Business Mailing Address
First Line	:	4021 W WALNUT ST # 1132
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72756-1842
Country	:	US
Telephone Number	:	479-310-5483
Fax Number	:	479-397-3710

Provider Business Practice Location Address
First Line	:	329 N GARNETT CT
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72701-7583
Country	:	US
Telephone Number	:	479-310-5483
Fax Number	:	479-310-5483

Authorized Official
Title or Position	:	CEO/MANAGING DIRECTOR
Name	:	JOANNA RUSSELL
Credential	:	LCSW
Telephone Number	:	479-310-5483

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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