Provider Demographics
NPI:1629876834
Name:SAGEBRUSH THERAPY LLC
Entity type:Organization
Organization Name:SAGEBRUSH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:LYVER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:385-213-7136
Mailing Address - Street 1:1399 S 700 E STE 1
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2100
Mailing Address - Country:US
Mailing Address - Phone:385-213-7136
Mailing Address - Fax:
Practice Address - Street 1:1399 S 700 E STE 1
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2100
Practice Address - Country:US
Practice Address - Phone:385-213-7136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty