Provider Demographics
NPI:1063299857
Name:STARLIGHT BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:STARLIGHT BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, CEO, CCD
Authorized Official - Prefix:
Authorized Official - First Name:BRIGETTE
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:SPRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-622-5917
Mailing Address - Street 1:18330 SW DELINE ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97078-3814
Mailing Address - Country:US
Mailing Address - Phone:602-622-5917
Mailing Address - Fax:
Practice Address - Street 1:18330 SW DELINE ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97078-3814
Practice Address - Country:US
Practice Address - Phone:602-622-5917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty