Provider Demographics
NPI:1275820912
Name:STARR, LEANNE R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LEANNE
Middle Name:R
Last Name:STARR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HUNTINGTON PL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4316
Mailing Address - Country:US
Mailing Address - Phone:719-428-5211
Mailing Address - Fax:719-634-3847
Practice Address - Street 1:120 HUNTINGTON PL
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4316
Practice Address - Country:US
Practice Address - Phone:719-428-5211
Practice Address - Fax:719-634-3847
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3446103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO44351381Medicaid