Healthcare Provider Details

I. General information

NPI: 1992859664
Provider Name (Legal Business Name): DANIAL SCOTT STURGILL PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 4TH ST S
FARGO ND
58103-1929
US

IV. Provider business mailing address

100 4TH ST S
FARGO ND
58103-1929
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-3130
  • Fax: 701-234-3168
Mailing address:
  • Phone: 701-234-3130
  • Fax: 701-234-3168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1087
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number454
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier119625
Identifier TypeOTHER
Identifier StateKS
Identifier IssuerBCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: