# SAGE MENTAL, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205588506
- **Authorized official:** AMANDA LILES APRN (OWNER)
- **Authorized official phone:** (850) 502-3090

## Contact information

- **Practice address:** 7901 4TH ST N STE 300, ST PETERSBURG, FL 33702-4399
- **Practice address phone:** (850) 290-7331
- **Mailing address:** PO BOX 4418, FORT WALTON BEACH, FL 32549-4418
- **Mailing address phone:** (850) 502-3090

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 01/19/2022
- **Last updated:** 06/04/2022