Provider Demographics
NPI:1891201521
Name:DESERT SAGE HEALTH PLLC
Entity type:Organization
Organization Name:DESERT SAGE HEALTH PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOOL
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:623-536-7956
Mailing Address - Street 1:2620 N 140TH AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2437
Mailing Address - Country:US
Mailing Address - Phone:623-536-7956
Mailing Address - Fax:623-536-9806
Practice Address - Street 1:2620 N 140TH AVE
Practice Address - Street 2:STE 101
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2437
Practice Address - Country:US
Practice Address - Phone:623-536-7956
Practice Address - Fax:623-536-9806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-18
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty