Provider Demographics
NPI:1851638720
Name:STURM, THEDA (LMFT)
Entity Type:Individual
Prefix:
First Name:THEDA
Middle Name:
Last Name:STURM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4232 LAKE ELEANOR DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-4302
Mailing Address - Country:US
Mailing Address - Phone:352-315-7100
Mailing Address - Fax:352-360-6582
Practice Address - Street 1:201 E MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-3583
Practice Address - Country:US
Practice Address - Phone:352-315-7100
Practice Address - Fax:352-360-6582
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2744106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist