Provider Demographics
NPI:1720726227
Name:STARR, MICHAEL ANN (LCSW, RPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANN
Last Name:STARR
Suffix:
Gender:F
Credentials:LCSW, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 SANDHILL CRAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-4747
Mailing Address - Country:US
Mailing Address - Phone:312-213-5497
Mailing Address - Fax:
Practice Address - Street 1:208 SANDHILL CRAIN ST
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-4747
Practice Address - Country:US
Practice Address - Phone:312-213-5497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX658911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty