Provider Demographics
NPI:1275848699
Name:O'BRIEN, SAGE J (CSW, LSAC)
Entity Type:Individual
Prefix:
First Name:SAGE
Middle Name:J
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:CSW, LSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 W TOWNE RIDGE PKWY STE 225
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2113
Mailing Address - Country:US
Mailing Address - Phone:801-669-1269
Mailing Address - Fax:801-669-5889
Practice Address - Street 1:230 W TOWNE RIDGE PKWY STE 225
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2113
Practice Address - Country:US
Practice Address - Phone:801-669-1269
Practice Address - Fax:801-669-5889
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6573731-35021041C0700X
UT6573731-6006101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)