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NPI Code Detail

MEDICARE: EBONI STARKS PHD, HSPP

MEDICARE: EBONI STARKS PHD, HSPP
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
1103TC0700XClinical Psychologist20043668AIN

General Provider Information

NPI Number : 1760160469
Entity Type Code : Individual
Provider Name (Legal Business Name) : EBONI STARKS PHD, HSPP
Provider Business Mailing Address
First Line : 1224 PROSPECT ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46203-1979
Country : US
Telephone Number : 317-750-0782
Fax Number :
Provider Business Practice Location Address
First Line : 1224 PROSPECT ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46203-1979
Country : US
Telephone Number : 317-750-0782
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2023
Last Update Date : 12/09/2025

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Directions to “ EBONI STARKS PHD, HSPP” Practice Location

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