Provider Demographics
NPI:1487800058
Name:SAURAGE, JUDITH LYNN (LPC)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:LYNN
Last Name:SAURAGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 REMINGTON OAKS COURT
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-7024
Mailing Address - Country:US
Mailing Address - Phone:314-620-6238
Mailing Address - Fax:
Practice Address - Street 1:2715 CHEROKEE ST
Practice Address - Street 2:SUITE 36 CHEROKEE PLACE
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-3042
Practice Address - Country:US
Practice Address - Phone:314-629-9912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002678101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor