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General NPI Number Information
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NPI Number | 1619114972
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Entity Type | Organization
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Legal Business Name | THE STARLIGHT CENTER, INC.
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Dates
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Enumeration Date | 01/08/2009
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Last Update Date | 10/14/2009
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Provider Practice Location Address
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Address Line | 111 W CENTER AVE STE 3
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City | SEBRING
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State | FL
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Zip | 33870-3104
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Country | US
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Telephone | 863-402-9182
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Fax | 863-402-9183
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Provider Business Mailing Address
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Address Line | 111 W CENTER AVE STE 3
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City | SEBRING
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State | FL
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Zip | 33870-3104
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Country | US
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Telephone | 863-402-9182
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Fax | 863-402-9183
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. TIA AILEEN KERN-BUTLER
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Credential | PSY.D.
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Telephone | 863-402-9182
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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 | PY6186
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License Number State | FL
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