MEDICARE: LORI ANNE PAGE

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	103TC0700X	Clinical Psychologist	30406	CA
2	103TC0700X	Clinical Psychologist	40306	TX

General Provider Information

NPI Number	:	1386893915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI ANNE PAGE

Provider Business Mailing Address
First Line	:	8642 SAN BENITO WAY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75218-7521
Country	:	US
Telephone Number	:	214-558-9197
Fax Number	:

Provider Business Practice Location Address
First Line	:	8642 SAN BENITO WAY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75218-7521
Country	:	US
Telephone Number	:	214-558-9197
Fax Number	:

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

Provider Enumeration Date	:	09/18/2008
Last Update Date	:	10/23/2024

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Directions to “ LORI ANNE PAGE ” Practice Location

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