Provider Demographics
NPI:1902841455
Name:STURTEVANT, WILLIAM J (PHD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:STURTEVANT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 WARD ROAD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1829
Mailing Address - Country:US
Mailing Address - Phone:303-278-7418
Mailing Address - Fax:
Practice Address - Street 1:2 EAST TILDEN
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-1648
Practice Address - Country:US
Practice Address - Phone:317-852-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040306A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000232186OtherANTHEM
IN20224870AMedicaid
IN680010869OtherRAILROAD
IN131860Medicare ID - Type Unspecified