Provider Demographics
NPI:1548640964
Name:STARR FAMILY BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:STARR FAMILY BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TRENT
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:208-908-6399
Mailing Address - Street 1:7161 W POTOMAC DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9148
Mailing Address - Country:US
Mailing Address - Phone:208-908-6399
Mailing Address - Fax:866-275-9883
Practice Address - Street 1:7161 W POTOMAC DR
Practice Address - Street 2:SUITE A
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9148
Practice Address - Country:US
Practice Address - Phone:208-908-6399
Practice Address - Fax:866-275-9883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-30318251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health