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General NPI Number Information
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NPI Number | 1477439644
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Entity Type | Organization
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Legal Business Name | STAR CENTER
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Dates
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Enumeration Date | 08/13/2025
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 182 SW 10TH ST
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City | ONTARIO
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State | OR
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Zip | 97914-2134
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Country | US
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Telephone | 541-881-0153
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Fax |
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Provider Business Mailing Address
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Address Line | 182 SW 10TH ST
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City | ONTARIO
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State | OR
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Zip | 97914-2134
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Country | US
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Telephone | 541-881-0153
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Fax |
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Authorized Official
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Title or Position | ADVOCATE/ADMIN ASSISTANT
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Name | STEPHANIE PETRIDGE
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Credential |
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Telephone | 541-881-0153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2080C0008X
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Taxonomy Name | Child Abuse Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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