Provider Demographics
NPI:1063129989
Name:COSTELLO-STRONG, STIRLING THOMAS
Entity type:Individual
Prefix:
First Name:STIRLING
Middle Name:THOMAS
Last Name:COSTELLO-STRONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:STIRLING
Other - Middle Name:
Other - Last Name:STRONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7917 OSTROW ST STE A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3604
Mailing Address - Country:US
Mailing Address - Phone:858-399-8282
Mailing Address - Fax:
Practice Address - Street 1:7917 OSTROW ST STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3604
Practice Address - Country:US
Practice Address - Phone:858-399-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137202106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist