Provider Demographics
NPI:1558413187
Name:STARR, CHARLES KENTON (MFT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:KENTON
Last Name:STARR
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:C
Other - Middle Name:KENTON
Other - Last Name:STARR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2001 THE ALAMEDA
Mailing Address - Street 2:ALLIANCE FOR COMMUNITY CARE
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1136
Mailing Address - Country:US
Mailing Address - Phone:408-261-7777
Mailing Address - Fax:408-254-9960
Practice Address - Street 1:2001 THE ALAMEDA
Practice Address - Street 2:ALLIANCE FOR COMMUNITY CARE SRVC TEAM ADULT OUTPATIENT
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1136
Practice Address - Country:US
Practice Address - Phone:408-261-7777
Practice Address - Fax:408-254-9960
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22687106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist