Healthcare Provider Details

I. General information

NPI: 1245594431
Provider Name (Legal Business Name): STARLIGHT COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1885 LUNDY AVE STE 223
SAN JOSE CA
95131-1888
US

IV. Provider business mailing address

1885 LUNDY AVE STE 223
SAN JOSE CA
95131-1888
US

V. Phone/Fax

Practice location:
  • Phone: 408-284-9010
  • Fax: 408-284-9048
Mailing address:
  • Phone: 408-284-9010
  • Fax: 408-284-9048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SUSAN REYNOLDS
Title or Position: HUMAN RESOURCES MANAGER
Credential:
Phone: 408-284-9010