Healthcare Provider Details

I. General information

NPI: 1457005647
Provider Name (Legal Business Name): QUINT PAIGE LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S EUCLID AVE STE 3
PASADENA CA
91101-2471
US

IV. Provider business mailing address

130 S EUCLID AVE STE 3
PASADENA CA
91101-2471
US

V. Phone/Fax

Practice location:
  • Phone: 626-676-3381
  • Fax:
Mailing address:
  • Phone: 626-676-3381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT36404
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: