Provider Demographics
NPI:1578102984
Name:SAGE PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:SAGE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LENARD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:732-310-8583
Mailing Address - Street 1:453 DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2102
Mailing Address - Country:US
Mailing Address - Phone:732-310-8583
Mailing Address - Fax:
Practice Address - Street 1:14 2ND ST W STE 20
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-3036
Practice Address - Country:US
Practice Address - Phone:406-318-7775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health