Provider Demographics
NPI:1093495285
Name:CALLINS, STARLETTE Y
Entity Type:Individual
Prefix:
First Name:STARLETTE
Middle Name:Y
Last Name:CALLINS
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 1:4045 E UNION HILLS DR STE A109
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-3386
Mailing Address - Country:US
Mailing Address - Phone:602-675-2177
Mailing Address - Fax:602-675-3025
Practice Address - Street 1:4045 E UNION HILLS DR STE A109
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-3386
Practice Address - Country:US
Practice Address - Phone:602-675-2177
Practice Address - Fax:602-675-3025
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst