Healthcare Provider Details

I. General information

NPI: 1255060901
Provider Name (Legal Business Name): KATIE E PAGE MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 CHERRY ST # 7
SANTA ROSA CA
95404-4202
US

IV. Provider business mailing address

633 CHERRY ST # 7
SANTA ROSA CA
95404-4202
US

V. Phone/Fax

Practice location:
  • Phone: 707-353-4798
  • Fax:
Mailing address:
  • Phone: 707-353-4798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164906
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: