| NPI | 1861158610 |
|---|---|
| Doing Business As | RUSTIC SAGE LLC |
| Entity Type | Organization |
| Authorized Contact | ANDRE B PRUITT Owner 503-860-1213 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2021-11-16 |
| Last Update Date | 2024-06-20 |