Provider Demographics
NPI:1801031984
Name:S.A.G.E. THERAPY CENTER
Entity Type:Organization
Organization Name:S.A.G.E. THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:MOOREHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:MA MFT
Authorized Official - Phone:760-703-2188
Mailing Address - Street 1:1445 CAMINITO SEPTIMO
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-1028
Mailing Address - Country:US
Mailing Address - Phone:760-703-2188
Mailing Address - Fax:760-729-7050
Practice Address - Street 1:2774 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1703
Practice Address - Country:US
Practice Address - Phone:858-779-1099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty