Provider Demographics
NPI:1932612348
Name:SAGE WELLNESS, A MARRIAGE AND FAMILY THERAPY CORPORATION
Entity Type:Organization
Organization Name:SAGE WELLNESS, A MARRIAGE AND FAMILY THERAPY CORPORATION
Other - Org Name:SAGE WELLNESS: COUNSELING AND CONSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWERSOX-MOREHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:760-566-7738
Mailing Address - Street 1:100 E SAN MARCOS BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-2988
Mailing Address - Country:US
Mailing Address - Phone:760-566-7738
Mailing Address - Fax:760-919-3139
Practice Address - Street 1:100 E SAN MARCOS BLVD STE 400
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2988
Practice Address - Country:US
Practice Address - Phone:760-566-7738
Practice Address - Fax:760-919-3139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-07
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)