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General NPI Number Information
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NPI Number | 1285149658
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Entity Type | Individual
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Provider Name | TIMOTHY MERLE STURGILL QMHS, LCDCIII, BA
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Gender | Male
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Dates
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Enumeration Date | 12/07/2017
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 5665 HOOVER RD
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City | GROVE CITY
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State | OH
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Zip | 43123-9122
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Country | US
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Telephone | 614-875-2371
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Fax |
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Provider Business Mailing Address
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Address Line | 157 MEADOWLARK LN
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City | COLUMBUS
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State | OH
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Zip | 43214-1233
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Country | US
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Telephone | 614-397-9540
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCDCIII.161734
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License Number State | OH
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