Provider Demographics
NPI:1306144787
Name:PAGE, LISA E (LPC)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:E
Last Name:PAGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ELIZABETH
Other - Last Name:CROAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:2110 W SLAUGHTER LANE
Mailing Address - Street 2:SUITE 107 BOX 591
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-5992
Mailing Address - Country:US
Mailing Address - Phone:736-262-0858
Mailing Address - Fax:210-598-1910
Practice Address - Street 1:2500 W. WILLIAMS CANNON DRIVE
Practice Address - Street 2:SUITE 607
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-5320
Practice Address - Country:US
Practice Address - Phone:736-262-0858
Practice Address - Fax:210-598-1910
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional