Provider Demographics
NPI:1770639379
Name:SAGE PROFESSIONAL CONSULTING CORPORATION
Entity Type:Organization
Organization Name:SAGE PROFESSIONAL CONSULTING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:CARLTON
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:979-530-8246
Mailing Address - Street 1:TWO SAINT MARK'S PL STE 147
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945
Mailing Address - Country:US
Mailing Address - Phone:979-530-8246
Mailing Address - Fax:
Practice Address - Street 1:TWO SAINT MARK'S PL STE 147
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945
Practice Address - Country:US
Practice Address - Phone:979-530-8246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33121103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty