Provider Demographics
NPI:1992338271
Name:TURNER, JERRY (LEP)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:
Last Name:TURNER
Suffix:
Gender:M
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1584 GREEN CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-7365
Mailing Address - Country:US
Mailing Address - Phone:951-453-8721
Mailing Address - Fax:
Practice Address - Street 1:1584 GREEN CREEK TRL
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-7365
Practice Address - Country:US
Practice Address - Phone:951-453-8721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2966103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool