Healthcare Provider Details

I. General information

NPI: 1407265382
Provider Name (Legal Business Name): STERLING EVISON M.A., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2014
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10349 NW RAND ST
SEAL ROCK OR
97376-9737
US

IV. Provider business mailing address

PO BOX 384
SEAL ROCK OR
97376-0384
US

V. Phone/Fax

Practice location:
  • Phone: 916-304-4449
  • Fax:
Mailing address:
  • Phone: 916-304-4449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2370
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number88971
License Number StateCA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: