Healthcare Provider Details

I. General information

NPI: 1477141067
Provider Name (Legal Business Name): SIERRA L STOTTSBERRY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SIERRA LYNN MARTIN PH.D.

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 01/08/2023
Certification Date: 01/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6502 BANDERA RD STE 211
SAN ANTONIO TX
78238-1400
US

IV. Provider business mailing address

6502 BANDERA RD STE 211
SAN ANTONIO TX
78238-1400
US

V. Phone/Fax

Practice location:
  • Phone: 210-281-4335
  • Fax: 210-944-4495
Mailing address:
  • Phone: 210-281-4335
  • Fax: 210-944-4495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT134262
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State
# 9
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: