Provider Demographics
NPI:1053825331
Name:SAGE, CRYSTAL JEANNE (MA, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:JEANNE
Last Name:SAGE
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4726 ASHURST ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-2816
Mailing Address - Country:US
Mailing Address - Phone:863-866-7065
Mailing Address - Fax:352-309-0769
Practice Address - Street 1:4726 ASHURST ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-2816
Practice Address - Country:US
Practice Address - Phone:863-866-7065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-26
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health