Provider Demographics
NPI:1245278134
Name:FIRSTSTARR REHABILITATION & BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:FIRSTSTARR REHABILITATION & BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ABIOLA
Authorized Official - Middle Name:OLUSOLA
Authorized Official - Last Name:DIPEOLU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:316-201-1273
Mailing Address - Street 1:4402 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3912
Mailing Address - Country:US
Mailing Address - Phone:316-201-1273
Mailing Address - Fax:316-260-9389
Practice Address - Street 1:4402 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3912
Practice Address - Country:US
Practice Address - Phone:316-201-1273
Practice Address - Fax:316-260-9389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1061103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty