Healthcare Provider Details

I. General information

NPI: 1942396205
Provider Name (Legal Business Name): LINDSAY PAGE SOUTH MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1591 W CENTRE ST SUITE 103
PORTAGE MI
49024
US

IV. Provider business mailing address

1591 W CENTRE ST SUITE 103
PORTAGE MI
49024
US

V. Phone/Fax

Practice location:
  • Phone: 269-323-2553
  • Fax: 289-323-2558
Mailing address:
  • Phone: 269-323-2553
  • Fax: 289-323-2558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401005843
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301007223
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: