Provider Demographics
NPI:1518208941
Name:PAGE, MARY ARLENE (PEER SUPPORT LIASON)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ARLENE
Last Name:PAGE
Suffix:
Gender:F
Credentials:PEER SUPPORT LIASON
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:OBERLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70655-3519
Mailing Address - Country:US
Mailing Address - Phone:337-639-3001
Mailing Address - Fax:337-639-3008
Practice Address - Street 1:402 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:LA
Practice Address - Zip Code:70655-3519
Practice Address - Country:US
Practice Address - Phone:337-639-3001
Practice Address - Fax:337-639-3008
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101Y00000X, 175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1710580Medicaid