Provider Demographics
NPI:1730633058
Name:GAIL A. STARKS PLLC
Entity type:Organization
Organization Name:GAIL A. STARKS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:STARKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-842-8297
Mailing Address - Street 1:1851 DOROTHEA RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1807
Mailing Address - Country:US
Mailing Address - Phone:248-842-8297
Mailing Address - Fax:
Practice Address - Street 1:1851 DOROTHEA RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1807
Practice Address - Country:US
Practice Address - Phone:248-842-8297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003908103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty