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General NPI Number Information
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NPI Number | 1912134933
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Entity Type | Organization
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Legal Business Name | STAR FOUNDATION
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Dates
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Enumeration Date | 06/17/2009
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Last Update Date | 01/30/2015
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Provider Practice Location Address
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Address Line | 2200 US HIGHWAY 441 SE
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City | OKEECHOBEE
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State | FL
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Zip | 34974-7322
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Country | US
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Telephone | 707-857-3359
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 516
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City | GEYSERVILLE
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State | CA
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Zip | 95441-0516
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Country | US
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Telephone | 707-857-3359
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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 | MS. DIANA BARRETT
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Credential |
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Telephone | 707-857-3359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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