Provider Demographics
NPI:1275390767
Name:STURTZ, JESSE RYAN (MHC-LP)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:RYAN
Last Name:STURTZ
Suffix:
Gender:M
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 FLATBUSH AVE UNIT 340152
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4530
Mailing Address - Country:US
Mailing Address - Phone:718-664-4689
Mailing Address - Fax:
Practice Address - Street 1:2222 FLATBUSH AVE UNIT 340152
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4530
Practice Address - Country:US
Practice Address - Phone:718-664-4689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18-P127423-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health