Provider Demographics
NPI:1528884756
Name:BLUE SAGE COUNSELING, LLC
Entity type:Organization
Organization Name:BLUE SAGE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEIJI
Authorized Official - Middle Name:S
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-402-6974
Mailing Address - Street 1:4552 N CITRUS AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-9556
Mailing Address - Country:US
Mailing Address - Phone:208-402-6974
Mailing Address - Fax:
Practice Address - Street 1:4552 N CITRUS AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-9556
Practice Address - Country:US
Practice Address - Phone:208-402-6974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty