Provider Demographics
NPI:1003265760
Name:KELTON-LOCKE, STARR
Entity Type:Individual
Prefix:
First Name:STARR
Middle Name:
Last Name:KELTON-LOCKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 SIR FRANCIS DRAKE BLVD
Mailing Address - Street 2:STE. 100
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1411
Mailing Address - Country:US
Mailing Address - Phone:415-453-2782
Mailing Address - Fax:415-457-9932
Practice Address - Street 1:1030 SIR FRANCIS DRAKE BLVD
Practice Address - Street 2:STE. 100
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1411
Practice Address - Country:US
Practice Address - Phone:415-453-2782
Practice Address - Fax:415-457-9932
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16108103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist