Healthcare Provider Details

I. General information

NPI: 1174672315
Provider Name (Legal Business Name): BENJAMIN F STURGEON MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BEN STURGEON

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1632 S CREEK RD
DERBY NY
14047-9723
US

IV. Provider business mailing address

1632 S CREEK RD
DERBY NY
14047-9723
US

V. Phone/Fax

Practice location:
  • Phone: 719-244-8484
  • Fax:
Mailing address:
  • Phone: 719-244-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5174
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: