Provider Demographics
NPI:1831554625
Name:STARCK, JAIME (MA, LPC)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:STARCK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44434 MCKENZIE HWY
Mailing Address - Street 2:
Mailing Address - City:LEABURG
Mailing Address - State:OR
Mailing Address - Zip Code:97489-9633
Mailing Address - Country:US
Mailing Address - Phone:541-556-5059
Mailing Address - Fax:
Practice Address - Street 1:44434 MCKENZIE HWY
Practice Address - Street 2:
Practice Address - City:LEABURG
Practice Address - State:OR
Practice Address - Zip Code:97489-9633
Practice Address - Country:US
Practice Address - Phone:541-556-5059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-21
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health