Provider Demographics
NPI:1386893915
Name:PAGE, LORI ANNE
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ANNE
Last Name:PAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8642 SAN BENITO WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-7521
Mailing Address - Country:US
Mailing Address - Phone:214-558-9197
Mailing Address - Fax:
Practice Address - Street 1:8642 SAN BENITO WAY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-7521
Practice Address - Country:US
Practice Address - Phone:214-558-9197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30406103TC0700X
TX40306103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical