Provider Demographics
NPI:1003822081
Name:STURGEON, DAVID ALEXANDER (CSW-INTERN)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALEXANDER
Last Name:STURGEON
Suffix:
Gender:M
Credentials:CSW-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8777 ROPING RODEO AVE
Mailing Address - Street 2:UNIT 101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-8737
Mailing Address - Country:US
Mailing Address - Phone:702-807-4215
Mailing Address - Fax:702-486-4532
Practice Address - Street 1:7381 PRAIRIE FALCON RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0811
Practice Address - Country:US
Practice Address - Phone:702-468-1321
Practice Address - Fax:702-396-0015
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVIC-5441041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker