Provider Demographics
NPI:1760033963
Name:VANMETER, PAIGE THERESE
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:THERESE
Last Name:VANMETER
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 1:1125 JUDSON RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5192
Mailing Address - Country:US
Mailing Address - Phone:903-812-4874
Mailing Address - Fax:
Practice Address - Street 1:110 TRIPLE CREEK DR STE 78
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-3000
Practice Address - Country:US
Practice Address - Phone:903-812-4874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-28
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
TX10413106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10413OtherQABA
TX17-34170OtherRBT CERTIFICATION