Provider Demographics
NPI:1619785862
Name:PAGE NELSON THERAPY PLLC
Entity type:Organization
Organization Name:PAGE NELSON THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:443-739-7706
Mailing Address - Street 1:440 MCKAY PL
Mailing Address - Street 2:
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-2945
Mailing Address - Country:US
Mailing Address - Phone:443-739-7706
Mailing Address - Fax:
Practice Address - Street 1:440 MCKAY PL
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2945
Practice Address - Country:US
Practice Address - Phone:443-739-7706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-19
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty