MEDICARE: STARGAZER THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1235905027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARGAZER THERAPY LLC

Provider Business Mailing Address
First Line	:	1915 NE STUCKI AVE STE 308
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97006-6951
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7256 SE DOT ST
Second Line	:
City	:	ADAIR VILLAGE
State	:	OR
Zip	:	97330-6573
Country	:	US
Telephone Number	:	503-877-2358
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MRS. ELIZABETH JO SHERIDAN
Credential	:	LCSW
Telephone Number	:	503-877-2358

Provider Enumeration Date	:	12/01/2023
Last Update Date	:	12/01/2023

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Directions to “STARGAZER THERAPY LLC ” Practice Location

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