Provider Demographics
NPI:1073339156
Name:TURNER, MICKEY (MS)
Entity type:Individual
Prefix:
First Name:MICKEY
Middle Name:
Last Name:TURNER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 GLOVER AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2070
Mailing Address - Country:US
Mailing Address - Phone:254-371-5271
Mailing Address - Fax:
Practice Address - Street 1:557 GLOVER AVE STE 3
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2070
Practice Address - Country:US
Practice Address - Phone:334-308-2292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-23
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC05115101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health