Provider Demographics
NPI:1730534942
Name:PAGE, JEREMY
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:
Last Name:PAGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 E 9TH ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-2970
Mailing Address - Country:US
Mailing Address - Phone:360-909-8393
Mailing Address - Fax:
Practice Address - Street 1:1408 E 9TH ST
Practice Address - Street 2:UNIT 2
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-2970
Practice Address - Country:US
Practice Address - Phone:360-909-8393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health