Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 70300 | TX |
NPI | 1013661164 |
---|---|
Provider Name | Phillip Page |
First Address | Dallas, TX 75229-5500 |
Second Address | Dallas, TX 75229-5500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2022 |
Last Update Date | 08/02/2022 |