Provider Demographics
NPI:1609384296
Name:STARR, COREY
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:STARR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 BREVILLE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-3504
Mailing Address - Country:US
Mailing Address - Phone:318-343-8606
Mailing Address - Fax:
Practice Address - Street 1:806 N 31ST ST STE D
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3900
Practice Address - Country:US
Practice Address - Phone:318-855-3868
Practice Address - Fax:318-537-9688
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health