Provider Demographics
NPI:1184392680
Name:STURGILL, JESSICA BLAIR (LMFT LIC#247649)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:BLAIR
Last Name:STURGILL
Suffix:
Gender:F
Credentials:LMFT LIC#247649
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:BLAIR
Other - Last Name:SOBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT LIC#247649
Mailing Address - Street 1:6329 PEACH WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-5736
Mailing Address - Country:US
Mailing Address - Phone:619-977-4965
Mailing Address - Fax:
Practice Address - Street 1:6329 PEACH WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-5736
Practice Address - Country:US
Practice Address - Phone:619-977-4965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA127649101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA127649OtherMEDICAL