1093261703 NPI number — SAGE THERAPY & CONSULTING, LLC

Table of content: MRS. NILDA JUDITH CRUZ LCPC (NPI 1265107940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093261703 NPI number — SAGE THERAPY & CONSULTING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAGE THERAPY & CONSULTING, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093261703
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
328 S CENTRAL AVE
Provider Second Line Business Mailing Address:
SUITE 212
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-708-3018
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
328 S CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-708-3018
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
PORTER
Authorized Official First Name:
CHY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
541-708-3018

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  C2649 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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