Healthcare Provider Details

I. General information

NPI: 1104138130
Provider Name (Legal Business Name): RICHARD ALTON STARRETT PSYCHOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24511 W JAYNE AVE BOX 5000
COALINGA CA
93210-9503
US

IV. Provider business mailing address

793 E FOOTHILL BLVD STE A #179
SAN LUIS OBISPO CA
93405-1699
US

V. Phone/Fax

Practice location:
  • Phone: 559-934-3099
  • Fax: 559-934-3095
Mailing address:
  • Phone: 805-771-9868
  • Fax: 805-771-9868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 13628
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: