Provider Demographics
NPI:1982291233
Name:STURNER, SHASTA
Entity Type:Individual
Prefix:MRS
First Name:SHASTA
Middle Name:
Last Name:STURNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3461 LONE TREE ST SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-6249
Mailing Address - Country:US
Mailing Address - Phone:505-480-2936
Mailing Address - Fax:
Practice Address - Street 1:536 LOS LENTES RD SE
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-7052
Practice Address - Country:US
Practice Address - Phone:505-944-6626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor