Provider Demographics
NPI:1609266782
Name:SAGE BEHAVIORAL HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:SAGE BEHAVIORAL HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SAGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:816-813-1017
Mailing Address - Street 1:1801 NW PLATTE RD
Mailing Address - Street 2:SUITE 229
Mailing Address - City:RIVERSIDE
Mailing Address - State:MO
Mailing Address - Zip Code:64150-7509
Mailing Address - Country:US
Mailing Address - Phone:816-813-1017
Mailing Address - Fax:
Practice Address - Street 1:1801 NW PLATTE RD
Practice Address - Street 2:SUITE 229
Practice Address - City:RIVERSIDE
Practice Address - State:MO
Practice Address - Zip Code:64150-7509
Practice Address - Country:US
Practice Address - Phone:816-813-1017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012007968103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty