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General NPI Number Information
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NPI Number | 1265111587
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Entity Type | Organization
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Legal Business Name | STARRCHILD FOUNDATION
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Dates
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Enumeration Date | 07/13/2023
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 100 WILSHIRE BLVD STE 700
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City | SANTA MONICA
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State | CA
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Zip | 90401-3602
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Country | US
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Telephone | 347-949-9293
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Fax |
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Provider Business Mailing Address
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Address Line | 100 WILSHIRE BLVD STE 700
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City | SANTA MONICA
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State | CA
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Zip | 90401-3602
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Country | US
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Telephone | 347-949-9293
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Fax |
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Authorized Official
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Title or Position | BOARD CERTIFIED BEHAVIOR ANALYST
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Name | MS. JASEMINE MONET LAKEY
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Credential | BCBA
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Telephone | 951-550-3396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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