Provider Demographics
NPI:1780922393
Name:THE STARTING PLACE, LLC
Entity type:Organization
Organization Name:THE STARTING PLACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOVELACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-445-0089
Mailing Address - Street 1:PO BOX 10875
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38308-0114
Mailing Address - Country:US
Mailing Address - Phone:731-445-0089
Mailing Address - Fax:731-732-4083
Practice Address - Street 1:180 W. UNIVERSITY PKWY
Practice Address - Street 2:SUITE H
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1612
Practice Address - Country:US
Practice Address - Phone:731-499-2508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000056331041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103G702736Medicare PIN