Provider Demographics
NPI:1093296196
Name:BLUE SAGE TRANSITIONS THERAPY, PLLC
Entity Type:Organization
Organization Name:BLUE SAGE TRANSITIONS THERAPY, PLLC
Other - Org Name:BLUE SAGE TRANSITIONS THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTH
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:303-910-8507
Mailing Address - Street 1:1634 WALNUT ST STE 221
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5400
Mailing Address - Country:US
Mailing Address - Phone:608-219-1744
Mailing Address - Fax:720-729-0041
Practice Address - Street 1:1634 WALNUT ST STE 221
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5400
Practice Address - Country:US
Practice Address - Phone:608-219-1744
Practice Address - Fax:720-729-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-27
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001234106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty