MEDICARE: SAGE PSYCHIATRY NURSING CORPORATION

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1881535888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAGE PSYCHIATRY NURSING CORPORATION

Provider Business Mailing Address
First Line	:	224 W MAPLE AVE STE F
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92866-1366
Country	:	US
Telephone Number	:	657-325-7607
Fax Number	:	657-213-2674

Provider Business Practice Location Address
First Line	:	224 W MAPLE AVE STE F
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92866-1366
Country	:	US
Telephone Number	:	657-325-7607
Fax Number	:	657-213-2674

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TIFFANY FUTRELL
Credential	:	PMHNP
Telephone Number	:	657-325-7607

Provider Enumeration Date	:	04/03/2026
Last Update Date	:	04/03/2026

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