Provider Demographics
NPI:1881354223
Name:WALSH, SAGE (LPC)
Entity type:Individual
Prefix:
First Name:SAGE
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SAGE
Other - Middle Name:
Other - Last Name:ESPOSITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:1256 E UTOPIA RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-3617
Mailing Address - Country:US
Mailing Address - Phone:602-791-6624
Mailing Address - Fax:
Practice Address - Street 1:14040 N CAVE CREEK RD STE 205
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-6179
Practice Address - Country:US
Practice Address - Phone:602-358-7073
Practice Address - Fax:602-429-8602
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-21846101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLAC-19388OtherSTATE OF ARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS