MEDICARE: MRS. EBONY STURRUP LMFT, LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH22158	FL
2	106H00000X	Marriage & Family Therapist	MT3938	FL
3	106H00000X	Marriage & Family Therapist	166012166	IL

General Provider Information

NPI Number	:	1275149148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EBONY STURRUP LMFT, LMHC

Provider Business Mailing Address
First Line	:	7971 RIVIERA BLVD STE 112
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-6453
Country	:	US
Telephone Number	:	954-744-4369
Fax Number	:

Provider Business Practice Location Address
First Line	:	7971 RIVIERA BLVD STE 112
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-6453
Country	:	US
Telephone Number	:	954-744-4369
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2020
Last Update Date	:	05/29/2026

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