MEDICARE: MS. SHICAGO PAGE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	3098	AL
2	101YM0800X	Mental Health Counselor	72573	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285972059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHICAGO PAGE LPC

Provider Business Mailing Address
First Line	:	PO BOX 182434
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76096-2434
Country	:	US
Telephone Number	:	205-310-8225
Fax Number	:

Provider Business Practice Location Address
First Line	:	539 W COMMERCE ST # 1057
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-1953
Country	:	US
Telephone Number	:	469-951-3697
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2013
Last Update Date	:	10/05/2020

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