Provider Demographics
NPI:1356542716
Name:START, TONI SUE (LP)
Entity type:Individual
Prefix:DR
First Name:TONI
Middle Name:SUE
Last Name:START
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16306 W WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-1069
Mailing Address - Country:US
Mailing Address - Phone:616-607-4476
Mailing Address - Fax:
Practice Address - Street 1:320 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1289
Practice Address - Country:US
Practice Address - Phone:616-607-4476
Practice Address - Fax:616-935-7177
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014058103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical