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General NPI Number Information
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NPI Number | 1457778557
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Entity Type | Organization
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Legal Business Name | STARFISH HERO
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Dates
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Enumeration Date | 03/26/2014
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Last Update Date | 03/26/2014
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Provider Practice Location Address
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Address Line | 875 CRESCENT WAY
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City | ARCATA
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State | CA
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Zip | 95521-6741
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Country | US
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Telephone | 707-633-6242
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Fax | 707-416-0253
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Provider Business Mailing Address
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Address Line | PO BOX 1008
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City | ARCATA
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State | CA
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Zip | 95518-1008
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Country | US
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Telephone | 707-633-6242
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. KIER FLICKER
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Credential | BCBA
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Telephone | 707-633-6242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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