Organization Name: | STARKENBURG PSYCHOLOGICAL SERVICES, LLC |
NPI Number: | 1265814255 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DIANE STARKENBURG (PRESIDENT) |
Mailing Address: | 3250 Trinity Dr Ste D4 Los Alamos |
State: | NM US |
Postal Code: | 875442226 |
Phone Number: | 5056620468 |
Fax Number: | |
NPI Enumeration Date: | 06/25/2015 |
NPI Last Update Date: | 06/25/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 1134 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |