MEDICARE: SAGE COUNSELING COLLECTIVE

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1932725793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAGE COUNSELING COLLECTIVE

Provider Business Mailing Address
First Line	:	2142 W WELLINGTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-8156
Country	:	US
Telephone Number	:	847-471-0949
Fax Number	:

Provider Business Practice Location Address
First Line	:	2142 W WELLINGTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-8156
Country	:	US
Telephone Number	:	847-471-0949
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. BLAIR MCGUIRE
Credential	:	LCPC
Telephone Number	:	847-471-0949

Provider Enumeration Date	:	06/17/2020
Last Update Date	:	06/17/2020

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