MEDICARE: BRIDGET BAILEY PAIGE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	63038	TX
2	101YM0800X	Mental Health Counselor	909	WY

General Provider Information

NPI Number	:	1821274861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET BAILEY PAIGE LPC

Provider Business Mailing Address
First Line	:	1810 COUNTRY CLUB DR
Second Line	:	APT. 2
City	:	CROSBY
State	:	TX
Zip	:	77532-5051
Country	:	US
Telephone Number	:	713-890-2740
Fax Number	:

Provider Business Practice Location Address
First Line	:	11500 NORTHWEST FWY
Second Line	:	SUITE 235
City	:	HOUSTON
State	:	TX
Zip	:	77092-6530
Country	:	US
Telephone Number	:	713-956-8194
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2008
Last Update Date	:	01/19/2008

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