Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003327297 |
---|---|
Provider Name | John Leslie Sturges III |
First Address | Redding, CA 96001-5544 |
Second Address | Redding, CA 96001-5544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2017 |
Last Update Date | 16/10/2017 |