Healthcare Provider Details

I. General information

NPI: 1265814255
Provider Name (Legal Business Name): STARKENBURG PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 15TH ST STE A
LOS ALAMOS NM
87544-3000
US

IV. Provider business mailing address

1505 15TH ST STE A
LOS ALAMOS NM
87544-3000
US

V. Phone/Fax

Practice location:
  • Phone: 505-500-5894
  • Fax: 505-557-1140
Mailing address:
  • Phone: 505-500-5894
  • Fax: 505-557-1140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number1134
License Number StateNM

VIII. Authorized Official

Name: DIANE ARLENE STARKENBURG
Title or Position: PRESIDENT
Credential: PSY.D., MSCP
Phone: 505-500-5894