Provider Demographics
NPI:1124482401
Name:SAGAN, ADRIAN GARRETT (LCSW, LAC)
Entity type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:GARRETT
Last Name:SAGAN
Suffix:
Gender:M
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 HELENA AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3459
Mailing Address - Country:US
Mailing Address - Phone:303-918-0283
Mailing Address - Fax:
Practice Address - Street 1:825 HELENA AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3459
Practice Address - Country:US
Practice Address - Phone:303-918-0283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLAC-LAC-LIC-3435101YA0400X
MTBBH-LCSW-LIC-167071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)