1912211640 NPI number — DR. MICHELE NEACE PAGE EDD, NCP, LMHC

Table of content: DR. MICHELE NEACE PAGE EDD, NCP, LMHC (NPI 1912211640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912211640 NPI number — DR. MICHELE NEACE PAGE EDD, NCP, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAGE
Provider First Name:
MICHELE
Provider Middle Name:
NEACE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
EDD, NCP, LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912211640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2525 CHARLESTOWN ROAD
Provider Second Line Business Mailing Address:
FAIRMONT NEIGHBORHOOD CENTER
Provider Business Mailing Address City Name:
NEW ALBANY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-548-2051
Provider Business Mailing Address Fax Number:
812-941-5239

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 CHARLESTOWN RD
Provider Second Line Business Practice Location Address:
FAIRMONT NEIGHBORHOOD CENTER
Provider Business Practice Location Address City Name:
NEW ALBANY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47150-2556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-548-2051
Provider Business Practice Location Address Fax Number:
812-941-5239
Provider Enumeration Date:
08/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  39000847A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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