Provider Demographics
NPI:1972993475
Name:STAR AUTISM SUPPORT
Entity Type:Organization
Organization Name:STAR AUTISM SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EDUCATIONAL CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGEE-ARICK
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:503-297-2864
Mailing Address - Street 1:6663 SW BEAVERTON HILLSDALE HWY
Mailing Address - Street 2:BOX 119
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-1403
Mailing Address - Country:US
Mailing Address - Phone:503-297-2864
Mailing Address - Fax:503-292-4173
Practice Address - Street 1:9915 SW ARCTIC DR
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4194
Practice Address - Country:US
Practice Address - Phone:503-297-2864
Practice Address - Fax:503-292-4173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty