Provider Demographics
NPI:1477141067
Name:STOTTSBERRY, SIERRA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:SIERRA
Middle Name:L
Last Name:STOTTSBERRY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SIERRA
Other - Middle Name:LYNN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:6502 BANDERA RD STE 211
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1400
Mailing Address - Country:US
Mailing Address - Phone:210-281-4335
Mailing Address - Fax:210-944-4495
Practice Address - Street 1:6502 BANDERA RD STE 211
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1400
Practice Address - Country:US
Practice Address - Phone:210-281-4335
Practice Address - Fax:210-944-4495
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2023-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 174H00000X, 175L00000X, 101YP1600X, 246RP1900X, 374J00000X, 374K00000X, 175F00000X
TXMT134262225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopath
No171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator
No175L00000XOther Service ProvidersHomeopathGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoula
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner