Healthcare Provider Details

I. General information

NPI: 1780061937
Provider Name (Legal Business Name): STAR MEADOW COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 NE 7TH AVE STE 403
VANCOUVER WA
98685-4548
US

IV. Provider business mailing address

PO BOX 548
RIDGEFIELD WA
98642-0548
US

V. Phone/Fax

Practice location:
  • Phone: 360-952-3070
  • Fax: 360-205-2979
Mailing address:
  • Phone: 360-952-3070
  • Fax: 360-205-2979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ERICKA MARTIN
Title or Position: MENTAL HEALTH COUNSELOR, OWNER
Credential: LMHC
Phone: 360-952-3070