Provider Demographics
NPI:1699580928
Name:STARLIGHT PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:STARLIGHT PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-474-0555
Mailing Address - Street 1:2222 W GRAND RIVER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-1604
Mailing Address - Country:US
Mailing Address - Phone:734-602-4635
Mailing Address - Fax:
Practice Address - Street 1:2222 W GRAND RIVER AVE STE A
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1604
Practice Address - Country:US
Practice Address - Phone:734-602-4635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health