Provider Demographics
NPI:1073292298
Name:STARK, JANAE MILEY
Entity Type:Individual
Prefix:
First Name:JANAE
Middle Name:MILEY
Last Name:STARK
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 1:421 N BROOKHURST ST STE 119
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-5618
Mailing Address - Country:US
Mailing Address - Phone:714-361-0898
Mailing Address - Fax:714-276-2604
Practice Address - Street 1:421 N BROOKHURST ST STE 119
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5618
Practice Address - Country:US
Practice Address - Phone:714-361-0898
Practice Address - Fax:714-276-2604
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty