Provider Demographics
NPI:1073341822
Name:HUTH, STARLA SHAUN (RBT)
Entity type:Individual
Prefix:
First Name:STARLA
Middle Name:SHAUN
Last Name:HUTH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 PREXY DR
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-3435
Mailing Address - Country:US
Mailing Address - Phone:830-355-7913
Mailing Address - Fax:
Practice Address - Street 1:1401 UNIVERSAL CITY BLVD
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3317
Practice Address - Country:US
Practice Address - Phone:210-336-1524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24-362760106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician