Healthcare Provider Details

I. General information

NPI: 1720510811
Provider Name (Legal Business Name): BRITTNEE PAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 MARQUEZ PL UNIT D
SANTA FE NM
87505-1693
US

IV. Provider business mailing address

PO BOX 13289
DURHAM NC
27709-3289
US

V. Phone/Fax

Practice location:
  • Phone: 505-501-8485
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number19-329
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA15556
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: