MEDICARE: SAGE COUNSELING COLLECTIVE, LLC

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

General Provider Information

NPI Number	:	1215761903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAGE COUNSELING COLLECTIVE, LLC

Provider Business Mailing Address
First Line	:	414 MAPLE ST STE 1
Second Line	:
City	:	YUKON
State	:	OK
Zip	:	73099-2673
Country	:	US
Telephone Number	:	405-373-6477
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 MAPLE ST STE 1
Second Line	:
City	:	YUKON
State	:	OK
Zip	:	73099-2673
Country	:	US
Telephone Number	:	405-373-6477
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	MRS. SAMANTHA DAWES
Credential	:	LPC-S
Telephone Number	:	405-373-6477

Provider Enumeration Date	:	08/27/2024
Last Update Date	:	03/11/2026

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