Provider Demographics
NPI:1760119879
Name:SECOND STAR BEHAVIOR SERVICES
Entity Type:Organization
Organization Name:SECOND STAR BEHAVIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:TURBIN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:510-686-4321
Mailing Address - Street 1:PO BOX 18953
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-0953
Mailing Address - Country:US
Mailing Address - Phone:510-686-4321
Mailing Address - Fax:
Practice Address - Street 1:736 BEATIE ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-2179
Practice Address - Country:US
Practice Address - Phone:510-686-4321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty