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General NPI Number Information
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NPI Number | 1104979863
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Entity Type | Individual
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Provider Name | SUSAN PAGE
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Gender | Female
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7 VINE AVE NE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-5070
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Country | US
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Telephone | 850-863-2873
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Fax | 850-862-9292
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Provider Business Mailing Address
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Address Line | 259 E OAKDALE AVE
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City | CRESTVIEW
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State | FL
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Zip | 32539-3547
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Country | US
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Telephone | 850-628-1234
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Fax | 850-689-8799
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH3244
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License Number State | FL
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