MEDICARE: JESSICA BLAIR STURGILL LMFT LIC#247649

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	101YM0800X	Mental Health Counselor	127649	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	127649	OTHER	CA	MEDICAL

General Provider Information

NPI Number	:	1184392680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA BLAIR STURGILL LMFT LIC#247649

Provider Business Mailing Address
First Line	:	6329 PEACH WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-5736
Country	:	US
Telephone Number	:	619-977-4965
Fax Number	:

Provider Business Practice Location Address
First Line	:	6329 PEACH WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-5736
Country	:	US
Telephone Number	:	619-977-4965
Fax Number	:

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

Provider Enumeration Date	:	08/31/2021
Last Update Date	:	08/31/2021

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