Provider Demographics
NPI:1578845962
Name:BLUE SAGE COUNSELING AND PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:BLUE SAGE COUNSELING AND PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:E
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-463-1829
Mailing Address - Street 1:1839 BETTS ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-3103
Mailing Address - Country:US
Mailing Address - Phone:505-463-1829
Mailing Address - Fax:
Practice Address - Street 1:1839 BETTS ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-3103
Practice Address - Country:US
Practice Address - Phone:505-463-1829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-054931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM33827028Medicaid
NM1396894994OtherNPI
NM33827028Medicaid