MEDICARE: LEANNE STARR, PSY.D., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	3446	CO

General Provider Information

NPI Number	:	1629356043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEANNE STARR, PSY.D., P.C.

Provider Business Mailing Address
First Line	:	120 HUNTINGTON PL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4316
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 HUNTINGTON PL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4316
Country	:	US
Telephone Number	:	719-428-5211
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LEANNE STARR
Credential	:	PSY.D.
Telephone Number	:	719-310-6161

Provider Enumeration Date	:	08/02/2011
Last Update Date	:	07/31/2014

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