1104138130 NPI number — DR. RICHARD ALTON STARRETT PSYCHOLOGIST

Table of content: DR. RICHARD ALTON STARRETT PSYCHOLOGIST (NPI 1104138130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104138130 NPI number — DR. RICHARD ALTON STARRETT PSYCHOLOGIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STARRETT
Provider First Name:
RICHARD
Provider Middle Name:
ALTON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYCHOLOGIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104138130
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
793 E FOOTHILL BLVD STE A
Provider Second Line Business Mailing Address:
#179
Provider Business Mailing Address City Name:
SAN LUIS OBISPO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93405-1699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-771-9868
Provider Business Mailing Address Fax Number:
805-771-9868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24511 W JAYNE AVE
Provider Second Line Business Practice Location Address:
BOX 5000
Provider Business Practice Location Address City Name:
COALINGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93210-9503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-934-3099
Provider Business Practice Location Address Fax Number:
559-934-3095
Provider Enumeration Date:
07/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PSY 13628 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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