MEDICARE: LISA JEANECE PAIGE LCSW-S

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	1041C0700X	Clinical Social Worker	103419	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000	OTHER		N/A

General Provider Information

NPI Number	:	1396397329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA JEANECE PAIGE LCSW-S

Provider Business Mailing Address
First Line	:	969 ADAIR DR
Second Line	:
City	:	AUBREY
State	:	TX
Zip	:	76227-5642
Country	:	US
Telephone Number	:	678-663-8987
Fax Number	:

Provider Business Practice Location Address
First Line	:	5701 AIRPORT RD STE L103
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76502-7092
Country	:	US
Telephone Number	:	254-724-2585
Fax Number	:

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

Provider Enumeration Date	:	07/10/2019
Last Update Date	:	08/18/2025

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