1184392680 NPI number — JESSICA BLAIR STURGILL LMFT LIC#247649

Table of content: JESSICA BLAIR STURGILL LMFT LIC#247649 (NPI 1184392680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184392680 NPI number — JESSICA BLAIR STURGILL LMFT LIC#247649

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STURGILL
Provider First Name:
JESSICA
Provider Middle Name:
BLAIR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT LIC#247649
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SOBEL
Provider Other First Name:
JESSICA
Provider Other Middle Name:
BLAIR
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT LIC#247649
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184392680
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6329 PEACH WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92130-5736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-977-4965
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6329 PEACH WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92130-5736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-977-4965
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  127649 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 127649 . This is a "MEDICAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".