Provider Demographics
NPI:1407265382
Name:EVISON, STERLING (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:STERLING
Middle Name:
Last Name:EVISON
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:SEAL ROCK
Mailing Address - State:OR
Mailing Address - Zip Code:97376-0384
Mailing Address - Country:US
Mailing Address - Phone:916-304-4449
Mailing Address - Fax:
Practice Address - Street 1:10349 NW RAND ST
Practice Address - Street 2:
Practice Address - City:SEAL ROCK
Practice Address - State:OR
Practice Address - Zip Code:97376-9737
Practice Address - Country:US
Practice Address - Phone:916-304-4449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2370101YP2500X
CA88971106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional