Basic Information
| Provider Information | |||||||||
| NPI: | 1417196999 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STARKWEATHER | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | RACHAEL | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MA LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10 | ||||||||
| Address2: | |||||||||
| City: | MASON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488540010 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 212 KENT ST STE 4B | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488751448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174205627 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2009 | ||||||||
| LastUpdateDate: | 08/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | 6301013811 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.