Provider Demographics
NPI:1265111587
Name:STARRCHILD FOUNDATION
Entity type:Organization
Organization Name:STARRCHILD FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:MS
Authorized Official - First Name:JASEMINE
Authorized Official - Middle Name:MONET
Authorized Official - Last Name:LAKEY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:951-550-3396
Mailing Address - Street 1:100 WILSHIRE BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-3602
Mailing Address - Country:US
Mailing Address - Phone:347-949-9293
Mailing Address - Fax:
Practice Address - Street 1:100 WILSHIRE BLVD STE 700
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-3602
Practice Address - Country:US
Practice Address - Phone:347-949-9293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty