Provider Demographics
NPI:1265745590
Name:STARFISH CENTER, INC
Entity type:Organization
Organization Name:STARFISH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINCIAL PSYCHOLGIST/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GUTOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD LMSW CCS CAAC
Authorized Official - Phone:810-622-0630
Mailing Address - Street 1:38 S RIDGE ST # 306
Mailing Address - Street 2:
Mailing Address - City:PORT SANILAC
Mailing Address - State:MI
Mailing Address - Zip Code:48469-9789
Mailing Address - Country:US
Mailing Address - Phone:810-622-0630
Mailing Address - Fax:810-622-0631
Practice Address - Street 1:38 S RIDGE ST # 306
Practice Address - Street 2:
Practice Address - City:PORT SANILAC
Practice Address - State:MI
Practice Address - Zip Code:48469-9789
Practice Address - Country:US
Practice Address - Phone:810-622-0630
Practice Address - Fax:810-622-0631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801087602251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicaid
MIPENDINGMedicaid