Provider Demographics
NPI:1689080897
Name:SAGER, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SAGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10960 SNOW RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MI
Mailing Address - Zip Code:49241-9638
Mailing Address - Country:US
Mailing Address - Phone:517-563-8024
Mailing Address - Fax:517-563-2357
Practice Address - Street 1:330 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2121
Practice Address - Country:US
Practice Address - Phone:517-787-7920
Practice Address - Fax:517-787-2440
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013762101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional