Provider Demographics
NPI:1922446764
Name:PAGE, TRACI ELIZABETH (LMFT)
Entity Type:Individual
Prefix:MS
First Name:TRACI
Middle Name:ELIZABETH
Last Name:PAGE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5743 CORSA AVE
Mailing Address - Street 2:SUITE 221
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4027
Mailing Address - Country:US
Mailing Address - Phone:805-551-1041
Mailing Address - Fax:805-498-4627
Practice Address - Street 1:5743 CORSA AVE
Practice Address - Street 2:SUITE 221
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-4027
Practice Address - Country:US
Practice Address - Phone:805-551-1041
Practice Address - Fax:805-498-4627
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT89396106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist