Provider Demographics
NPI:1821358813
Name:STURGES, KATHERINE SUTHERLAND (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SUTHERLAND
Last Name:STURGES
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 SW MORRISON ST STE 619
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2217
Mailing Address - Country:US
Mailing Address - Phone:503-333-8534
Mailing Address - Fax:
Practice Address - Street 1:1130 SW MORRISON ST STE 619
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2217
Practice Address - Country:US
Practice Address - Phone:503-333-8534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4014101YP2500X, 101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator