Provider Demographics
NPI:1881980597
Name:SAGEWIND COACHING & COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:SAGEWIND COACHING & COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KENDALL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:440-473-9037
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:OH
Mailing Address - Zip Code:44021-0025
Mailing Address - Country:US
Mailing Address - Phone:440-473-9037
Mailing Address - Fax:
Practice Address - Street 1:16890 CLARIDON TROY RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:OH
Practice Address - Zip Code:44021-9657
Practice Address - Country:US
Practice Address - Phone:440-473-9037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty