Provider Demographics
NPI:1386208437
Name:STARFISH COUNSELING, LLC
Entity Type:Organization
Organization Name:STARFISH COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-730-2453
Mailing Address - Street 1:10433 PAMPLONA ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5607
Mailing Address - Country:US
Mailing Address - Phone:505-730-2453
Mailing Address - Fax:
Practice Address - Street 1:10433 PAMPLONA ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5607
Practice Address - Country:US
Practice Address - Phone:505-730-2453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty