Provider Demographics
NPI:1356354435
Name:PAGE, JOE WAYNE (MA LMFT)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:WAYNE
Last Name:PAGE
Suffix:
Gender:M
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:26 MIDWAY STREET
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620
Practice Address - Country:US
Practice Address - Phone:423-989-4500
Practice Address - Fax:423-989-4582
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000000197106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3085385OtherMAGELLAN NAVIGATOR
3085385OtherMAGELLAN PINNACLE
3085385OtherMAGELLAN SUMMIT
334969OtherVALUE OPTIONS GROUP