Provider Demographics
NPI:1023582392
Name:PRICE, CATHERINE PAGE
Entity type:Individual
Prefix:MISS
First Name:CATHERINE PAGE
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4638 TRAVIS ST APT 216
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-4048
Mailing Address - Country:US
Mailing Address - Phone:214-793-3408
Mailing Address - Fax:
Practice Address - Street 1:8150 N CENTRAL EXPY # M-1065
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-1815
Practice Address - Country:US
Practice Address - Phone:214-793-3408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77575101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional