Provider Demographics
NPI:1003020231
Name:BORROWED STAR PSYCHOLOGY GROUP, INC
Entity Type:Organization
Organization Name:BORROWED STAR PSYCHOLOGY GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARIZPE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-902-6089
Mailing Address - Street 1:1294 W 6TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-2987
Mailing Address - Country:US
Mailing Address - Phone:310-902-6089
Mailing Address - Fax:310-988-2883
Practice Address - Street 1:1294 W 6TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-2987
Practice Address - Country:US
Practice Address - Phone:310-902-6089
Practice Address - Fax:310-988-2883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17402103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty