Provider Demographics
NPI:1457778557
Name:STARFISH HERO
Entity Type:Organization
Organization Name:STARFISH HERO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIER
Authorized Official - Middle Name:
Authorized Official - Last Name:FLICKER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:707-633-6242
Mailing Address - Street 1:PO BOX 1008
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95518-1008
Mailing Address - Country:US
Mailing Address - Phone:707-633-6242
Mailing Address - Fax:
Practice Address - Street 1:875 CRESCENT WAY
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6741
Practice Address - Country:US
Practice Address - Phone:707-633-6242
Practice Address - Fax:707-416-0253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health