Provider Demographics
NPI:1073265997
Name:JUSTIN STARGAARD, MFT, LPCC, LLC
Entity Type:Organization
Organization Name:JUSTIN STARGAARD, MFT, LPCC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MFT / LPCC
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:STARGAARD
Authorized Official - Suffix:
Authorized Official - Credentials:MFT / LPCC
Authorized Official - Phone:559-549-3195
Mailing Address - Street 1:1398 W INDIANAPOLIS AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-0300
Mailing Address - Country:US
Mailing Address - Phone:559-549-3195
Mailing Address - Fax:
Practice Address - Street 1:1398 W INDIANAPOLIS AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-0300
Practice Address - Country:US
Practice Address - Phone:559-549-3195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1407224165OtherNPI NUMBER WHEN I WAS EMPLOYEE