Provider Demographics
NPI:1548029556
Name:STURGEON, DAVID M (MDIV, MA, ACMHC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:STURGEON
Suffix:
Gender:M
Credentials:MDIV, MA, ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4195 S WHIPOORWHIL ST
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-4809
Mailing Address - Country:US
Mailing Address - Phone:803-260-8071
Mailing Address - Fax:
Practice Address - Street 1:404 E 4500 S STE B22
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-2776
Practice Address - Country:US
Practice Address - Phone:801-268-1564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13589575-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health