Provider Demographics
NPI:1508456542
Name:SAGE, JENNIFER KRISTIN (LMFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KRISTIN
Last Name:SAGE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 CARMEL CREEPER PL
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-7706
Mailing Address - Country:US
Mailing Address - Phone:858-663-5424
Mailing Address - Fax:
Practice Address - Street 1:431 CARMEL CREEPER PL
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-7706
Practice Address - Country:US
Practice Address - Phone:858-663-5424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-23
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA116173101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health