Provider Demographics
NPI:1306222187
Name:PAGE, JONATHAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:PAGE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 S GREEN VALLEY PKWY # 1310
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-0404
Mailing Address - Country:US
Mailing Address - Phone:510-738-4078
Mailing Address - Fax:
Practice Address - Street 1:401 RYLAND ST STE 200A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1643
Practice Address - Country:US
Practice Address - Phone:510-738-4078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0005996103T00000X
NV1166103T00000X
CAPSY29526103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist