Provider Demographics
NPI:1124551254
Name:ELGIN, PAGE (MED, MS, LPC, RPT)
Entity Type:Individual
Prefix:
First Name:PAGE
Middle Name:
Last Name:ELGIN
Suffix:
Gender:F
Credentials:MED, MS, LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 CHERRY ST APT 301
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-6330
Mailing Address - Country:US
Mailing Address - Phone:713-366-2914
Mailing Address - Fax:
Practice Address - Street 1:1322 SPACE PARK DR STE C237
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3783
Practice Address - Country:US
Practice Address - Phone:713-366-2914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health