Provider Demographics
NPI:1316060114
Name:TURNER, JACKSON E JR (PHD)
Entity type:Individual
Prefix:DR
First Name:JACKSON
Middle Name:E
Last Name:TURNER
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:30425 LEEMOOR ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4916
Mailing Address - Country:US
Mailing Address - Phone:248-514-6476
Mailing Address - Fax:248-369-6389
Practice Address - Street 1:2525 CROOKS RD STE 100
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4733
Practice Address - Country:US
Practice Address - Phone:248-731-7305
Practice Address - Fax:248-731-7388
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008377103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical