Provider Demographics
NPI:1336674209
Name:PAGET, MISTYDAE
Entity Type:Individual
Prefix:MRS
First Name:MISTYDAE
Middle Name:
Last Name:PAGET
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 1:300 H ST
Mailing Address - Street 2:
Mailing Address - City:NEEDLES
Mailing Address - State:CA
Mailing Address - Zip Code:92363-2928
Mailing Address - Country:US
Mailing Address - Phone:760-326-4590
Mailing Address - Fax:
Practice Address - Street 1:300 H ST
Practice Address - Street 2:
Practice Address - City:NEEDLES
Practice Address - State:CA
Practice Address - Zip Code:92363-2928
Practice Address - Country:US
Practice Address - Phone:760-326-4590
Practice Address - Fax:760-326-3154
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5981101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)