Provider Demographics
NPI:1053772111
Name:STANGEBYE, SARAH GRACE (MS)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:GRACE
Last Name:STANGEBYE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3146
Mailing Address - Country:US
Mailing Address - Phone:970-964-2783
Mailing Address - Fax:970-964-2778
Practice Address - Street 1:95 MERCHANT DR STE B-1
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3025
Practice Address - Country:US
Practice Address - Phone:970-964-2783
Practice Address - Fax:970-964-2778
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0001030101YA0400X
COCSW.099254041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
COACD.0001030OtherDORA
COCSW.09925404OtherDORA