Provider Demographics
NPI:1154611663
Name:TURBETT, JACKLYN SUZANNE (LLPC)
Entity type:Individual
Prefix:MS
First Name:JACKLYN
Middle Name:SUZANNE
Last Name:TURBETT
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 FEDORA DR
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-1135
Mailing Address - Country:US
Mailing Address - Phone:517-392-2135
Mailing Address - Fax:
Practice Address - Street 1:3266 N ADRIAN HWY
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1144
Practice Address - Country:US
Practice Address - Phone:517-263-2625
Practice Address - Fax:517-263-7369
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012344101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)