Provider Demographics
NPI:1891201521
Name:DESERT SAGE HEALTH, PLLC
Entity Type:Organization
Organization Name:DESERT SAGE HEALTH, PLLC
Other - Org Name:WEST VALLEY FAMILY DEVELOPMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOOL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:623-536-7956
Mailing Address - Street 1:14872 N 142ND LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-8726
Mailing Address - Country:US
Mailing Address - Phone:623-308-5135
Mailing Address - Fax:
Practice Address - Street 1:3400 N DYSART RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-1003
Practice Address - Country:US
Practice Address - Phone:623-536-7956
Practice Address - Fax:623-536-9806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty