Healthcare Provider Details

I. General information

NPI: 1760119879
Provider Name (Legal Business Name): SECOND STAR BEHAVIOR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 BEATIE ST
OAKLAND CA
94606-2179
US

IV. Provider business mailing address

PO BOX 18953
OAKLAND CA
94619-0953
US

V. Phone/Fax

Practice location:
  • Phone: 510-686-4321
  • Fax:
Mailing address:
  • Phone: 510-686-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE LISA TURBIN
Title or Position: CLINICAL SUPERVISOR
Credential: BCBA
Phone: 510-686-4321