| Organization Name: | BORROWED STAR PSYCHOLOGY GROUP, INC |
| NPI Number: | 1003020231 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MELISSA ARIZPE (DIRECTOR) |
| Mailing Address: | 1294 W 6th St Suite 105 San Pedro |
| State: | CA US |
| Postal Code: | 907312987 |
| Phone Number: | 3109026089 |
| Fax Number: | 3109882883 |
| NPI Enumeration Date: | 05/09/2007 |
| NPI Last Update Date: | 01/21/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY17402 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |