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403 W 11th St Ste A Tracy CA 95376-3816 | |
(209) 222-8802 | |
(209) 255-4536 |
Full Name | |
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Speciality | Marriage & Family Therapist |
Location | 403 W 11th St Ste A, Tracy, California |
Authorized Official Name and Position | Jennifer Lee Starks (CEO) |
Authorized Official Contact | 2092228802 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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19663 Mountain House Pkwy Ste 333 Mountain House CA 95391-8042 Ph: (209) 222-8802 | 403 W 11th St Ste A Tracy CA 95376-3816 Ph: (209) 222-8802 |
NPI Number | 1568974244 |
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Provider Enumeration Date | 11/02/2017 |
Last Update Date | 11/13/2024 |
Certification Date | 11/13/2024 |
Medicare PECOS PAC ID | 6204362783 |
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Medicare Enrollment ID | O20241206002321 |
Identifier | Type | State | Issuer |
---|---|---|---|
1568974244 | NPI | - | NPPES |
1628542 | Medicaid | CA |
Provider Name | Jennifer Lee Starks |
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Provider Type | Practitioner - Marriage And Family Therapist |
Provider Identifiers | NPI Number: 1801272448 PECOS PAC ID: 7012443591 Enrollment ID: I20241209003546 |
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