Provider Demographics
NPI:1134248750
Name:STURGEON FREITAS, SHEILA (PHD)
Entity type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:
Last Name:STURGEON FREITAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SHEILA
Other - Middle Name:
Other - Last Name:STURGEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3709 N LOCUST GROVE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5924
Mailing Address - Country:US
Mailing Address - Phone:208-475-4690
Mailing Address - Fax:208-899-4703
Practice Address - Street 1:3709 N LOCUST GROVE RD STE 150
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5924
Practice Address - Country:US
Practice Address - Phone:208-475-4690
Practice Address - Fax:208-899-4703
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-202431103TF0000X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010168149OtherBLUE SHIELD OF IDAHO
N6342OtherBLUE CROSS OF IDAHO