Doctor Name: | EDNA STARR |
NPI Number: | 1033512496 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LACE |
License Number: | LAC-LAC-TMP-4114 |
Business Practice Address: | 2798 Meriwether St Missoula, MT - 598032934 |
Business Phone Number: | 4065440432 |
Business Fax Number: | |
Mailing Address: | 2798 Meriwether St, MISSOULA |
State: | MT |
Postal Code: | 598032934 |
Phone Number: | 4065440432 |
Fax Number: | |
NPI Enumeration Date: | 09/30/2014 |
NPI Last Update Date: | 09/30/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | LAC-LAC-TMP-4114 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |