Provider Demographics
NPI:1154676153
Name:PAGE, JAMES EDGAR (MA, LCDC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDGAR
Last Name:PAGE
Suffix:
Gender:M
Credentials:MA, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:ROPESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:79358-0095
Mailing Address - Country:US
Mailing Address - Phone:903-932-3075
Mailing Address - Fax:888-845-4706
Practice Address - Street 1:309 RANCH RD
Practice Address - Street 2:
Practice Address - City:ROPESVILLE
Practice Address - State:TX
Practice Address - Zip Code:79358-7022
Practice Address - Country:US
Practice Address - Phone:903-932-3075
Practice Address - Fax:888-845-4706
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12364101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX065363601Medicaid