MEDICARE: STERLING EVISON M.A., LMFT

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	101YP2500X	Professional Counselor	2370	CA
2	106H00000X	Marriage & Family Therapist	88971	CA

General Provider Information

NPI Number	:	1407265382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STERLING EVISON M.A., LMFT

Provider Business Mailing Address
First Line	:	PO BOX 384
Second Line	:
City	:	SEAL ROCK
State	:	OR
Zip	:	97376-0384
Country	:	US
Telephone Number	:	916-304-4449
Fax Number	:

Provider Business Practice Location Address
First Line	:	10349 NW RAND ST
Second Line	:
City	:	SEAL ROCK
State	:	OR
Zip	:	97376-9737
Country	:	US
Telephone Number	:	916-304-4449
Fax Number	:

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

Provider Enumeration Date	:	08/05/2014
Last Update Date	:	03/31/2020

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