Healthcare Provider Details

I. General information

NPI: 1477366490
Provider Name (Legal Business Name): STARLIGHT TRANSFORMATIVE COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 FLINTRIDGE DR STE 214
COLORADO SPRINGS CO
80918-4273
US

IV. Provider business mailing address

4740 FLINTRIDGE DR STE 214
COLORADO SPRINGS CO
80918-4273
US

V. Phone/Fax

Practice location:
  • Phone: 719-357-5546
  • Fax:
Mailing address:
  • Phone: 719-357-5546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY MALLETT
Title or Position: CEO
Credential:
Phone: 719-357-5546