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Organization

STAR CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
STEPHANIE PETRIDGE (ADVOCATE/ADMIN ASSISTANT)
(541) 881-0153
Entity
Organization

Contact information

Practice address
182 SW 10TH ST, ONTARIO, OR 97914-2134
(541) 881-0153
Mailing address
182 SW 10TH ST, ONTARIO, OR 97914-2134
(541) 881-0153

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
101YP2500X
Professional Counselor
171M00000X
Case Manager/Care Coordinator
Primary
208000000X
Pediatrics Physician
2080C0008X
Child Abuse Pediatrics Physician
363LF0000X
Family Nurse Practitioner

Other

Enumeration date
08/13/2025
Last updated
08/28/2025
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