MEDICARE: MR. DAVID ALEXANDER STURGEON CSW-INTERN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	IC-544	NV
2	104100000X	Social Worker	IC-544	NV

General Provider Information

NPI Number	:	1003822081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID ALEXANDER STURGEON CSW-INTERN

Provider Business Mailing Address
First Line	:	8777 ROPING RODEO AVE
Second Line	:	UNIT 101
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-8737
Country	:	US
Telephone Number	:	702-807-4215
Fax Number	:	702-486-4532

Provider Business Practice Location Address
First Line	:	7381 PRAIRIE FALCON RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0811
Country	:	US
Telephone Number	:	702-468-1321
Fax Number	:	702-396-0015

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	01/12/2010

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