Healthcare Provider Details

I. General information

NPI: 1497619522
Provider Name (Legal Business Name): ELIJAH STURGILL CT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 S 3RD ST
IRONTON OH
45638-2269
US

IV. Provider business mailing address

1724 S 3RD ST
IRONTON OH
45638-2269
US

V. Phone/Fax

Practice location:
  • Phone: 740-442-7143
  • Fax:
Mailing address:
  • Phone: 740-442-7143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2507264.TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: