Provider Demographics
NPI:1457936817
Name:MYERS, SAGE EMBRACE
Entity Type:Individual
Prefix:
First Name:SAGE
Middle Name:EMBRACE
Last Name:MYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 CAROLE DR NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98516-9236
Mailing Address - Country:US
Mailing Address - Phone:253-678-0086
Mailing Address - Fax:
Practice Address - Street 1:7224 PACIFIC HWY E
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WA
Practice Address - Zip Code:98354-9654
Practice Address - Country:US
Practice Address - Phone:253-220-6183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health