Provider Demographics
NPI:1932571015
Name:SAGE CIRCLE COUNSELING CENTER
Entity Type:Organization
Organization Name:SAGE CIRCLE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER
Authorized Official - Prefix:
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HURD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-229-9177
Mailing Address - Street 1:225 N BLUFF ST
Mailing Address - Street 2:SUITE #5
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4566
Mailing Address - Country:US
Mailing Address - Phone:435-229-9177
Mailing Address - Fax:
Practice Address - Street 1:225 N BLUFF ST
Practice Address - Street 2:SUITE #5
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4566
Practice Address - Country:US
Practice Address - Phone:435-229-9177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7027534-3501251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health