Provider Demographics
NPI:1548244635
Name:STARRETT, GEORGE T (EDD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:T
Last Name:STARRETT
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 NILES RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2473
Mailing Address - Country:US
Mailing Address - Phone:269-983-4751
Mailing Address - Fax:269-983-0803
Practice Address - Street 1:2095 NILES RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2473
Practice Address - Country:US
Practice Address - Phone:269-983-4751
Practice Address - Fax:269-983-0803
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007140103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN87700002Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER