Provider Demographics
NPI:1871374116
Name:STARFISH, LLC
Entity type:Organization
Organization Name:STARFISH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:VANDER LUGT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:414-491-9530
Mailing Address - Street 1:709 W STERLING OAK CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-4101
Mailing Address - Country:US
Mailing Address - Phone:414-491-9530
Mailing Address - Fax:
Practice Address - Street 1:4301 W 57TH ST STE 100
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2255
Practice Address - Country:US
Practice Address - Phone:605-335-1516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health