Most Relevant Information
Provider Data
| NPI Number: | 1003021635 |
| Provider Name: | SAGE MOUNTAINFIRE |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/14/2007 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
290 E GOBBI ST
UKIAH
CA
954825559
Practice Location Phone/Fax
| Phone: | 7074633300 |
| Fax: |
Provider Mailing Location
PO BOX 464
UKIAH
CA
954820464
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |