MEDICARE: KAREN GOLD SAGAL PHD

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	103TC1900X	Counseling Psychologist	464	NM

General Provider Information

NPI Number	:	1487767695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN GOLD SAGAL PHD

Provider Business Mailing Address
First Line	:	1990 E LOHMAN AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3172
Country	:	US
Telephone Number	:	505-524-6801
Fax Number	:	505-524-4813

Provider Business Practice Location Address
First Line	:	1990 E LOHMAN AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3172
Country	:	US
Telephone Number	:	505-524-6801
Fax Number	:	505-524-4813

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/08/2007

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