Healthcare Provider Details

I. General information

NPI: 1861834319
Provider Name (Legal Business Name): ANSLIE MERLE STARK PSY.D,. LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 PGA BLVD STE 310
PALM BEACH GARDENS FL
33410-2810
US

IV. Provider business mailing address

19390 COLLINS AVE PH 21
SUNNY ISLES BEACH FL
33160-2200
US

V. Phone/Fax

Practice location:
  • Phone: 561-983-6645
  • Fax: 954-277-2704
Mailing address:
  • Phone: 305-933-8647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH6421
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: