MEDICARE: GREGORY SAGE

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	6451019677	MI

General Provider Information

NPI Number	:	1255001178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY SAGE

Provider Business Mailing Address
First Line	:	2009 MAPLE NORTH TRL
Second Line	:
City	:	WIXOM
State	:	MI
Zip	:	48393-1867
Country	:	US
Telephone Number	:	248-787-5367
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 MAPLE NORTH TRL
Second Line	:
City	:	WIXOM
State	:	MI
Zip	:	48393-1867
Country	:	US
Telephone Number	:	248-787-5367
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2021
Last Update Date	:	09/14/2021

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Directions to “ GREGORY SAGE ” Practice Location

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