Provider Demographics
NPI:1326415209
Name:TURNER, MARY (MSW LCSW CCDP-D LLC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TURNER
Suffix:
Gender:F
Credentials:MSW LCSW CCDP-D LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 E KINGSLEY ST STE C
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7238
Mailing Address - Country:US
Mailing Address - Phone:417-882-7700
Mailing Address - Fax:417-882-7700
Practice Address - Street 1:1310 E KINGSLEY ST STE C
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7238
Practice Address - Country:US
Practice Address - Phone:417-862-3455
Practice Address - Fax:417-862-9771
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110349981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical