MEDICARE: DANCING SAGE THERAPY 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1790334035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANCING SAGE THERAPY LLC

Provider Business Mailing Address
First Line	:	6970 WHITE FIR LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-1258
Country	:	US
Telephone Number	:	719-641-5853
Fax Number	:

Provider Business Practice Location Address
First Line	:	1880 OFFICE CLUB PT STE 202
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-5008
Country	:	US
Telephone Number	:	719-494-5075
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	KATHARINE MG ZINK
Credential	:	LPC, NCC
Telephone Number	:	719-494-5075

Provider Enumeration Date	:	09/09/2019
Last Update Date	:	09/09/2019

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