MEDICARE: HEIDI LYN STURGEON

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	61087203	WA

General Provider Information

NPI Number	:	1295345981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI LYN STURGEON

Provider Business Mailing Address
First Line	:	9380 PHILLIPS RD SE
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98367-8535
Country	:	US
Telephone Number	:	360-850-7024
Fax Number	:

Provider Business Practice Location Address
First Line	:	7282 STINSON AVE STE B
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-4930
Country	:	US
Telephone Number	:	360-858-5846
Fax Number	:	253-858-4063

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

Provider Enumeration Date	:	08/06/2020
Last Update Date	:	08/06/2020

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