Provider Demographics
NPI:1417140229
Name:STARKS, MARY PATRICIA (MA, RC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:PATRICIA
Last Name:STARKS
Suffix:
Gender:F
Credentials:MA, RC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 WILSHIRE BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2335
Mailing Address - Country:US
Mailing Address - Phone:310-746-8235
Mailing Address - Fax:310-453-6565
Practice Address - Street 1:3201 WILSHIRE BLVD STE 310
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-2335
Practice Address - Country:US
Practice Address - Phone:310-746-8235
Practice Address - Fax:310-453-6565
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00054382101YP2500X
CA7728101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional