Basic Information
| Provider Information | |||||||||
| NPI: | 1760903587 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAGE COLLECTIVE LEARNING CONSULTANTS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE LEARNING CONSULTANTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2435 PYRAMID WAY STE B | ||||||||
| Address2: | |||||||||
| City: | SPARKS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894311865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7756578309 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2435 PYRAMID WAY STE B | ||||||||
| Address2: | |||||||||
| City: | SPARKS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894311865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7756578309 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2017 | ||||||||
| LastUpdateDate: | 01/25/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BONOW | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | A C | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER/CEO | ||||||||
| AuthorizedOfficialTelephone: | 7756578309 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | LBA0100 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.