Provider Demographics
NPI:1336788017
Name:PAGE, PHILIP KARL (LCDC)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:KARL
Last Name:PAGE
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 BIRDSONG DR APT W315
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3250
Mailing Address - Country:US
Mailing Address - Phone:832-984-8070
Mailing Address - Fax:
Practice Address - Street 1:1017 BIRDSONG DR APT W315
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3250
Practice Address - Country:US
Practice Address - Phone:832-984-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)