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General NPI Number Information
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NPI Number | 1285972059
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Entity Type | Individual
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Provider Name | SHICAGO PAGE LPC
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Gender | Female
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Dates
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Enumeration Date | 01/29/2013
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Last Update Date | 10/05/2020
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Provider Practice Location Address
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Address Line | 539 W COMMERCE ST # 1057
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City | DALLAS
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State | TX
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Zip | 75208-1953
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Country | US
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Telephone | 469-951-3697
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 182434
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City | ARLINGTON
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State | TX
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Zip | 76096-2434
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Country | US
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Telephone | 205-310-8225
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3098
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 72573
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License Number State | TX
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