MEDICARE: SUSANNA JANE TURNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	PSY.0006130	CO
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1093481459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANNA JANE TURNER

Provider Business Mailing Address
First Line	:	2625 REDWING RD STE 370
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6314
Country	:	US
Telephone Number	:	970-818-2004
Fax Number	:

Provider Business Practice Location Address
First Line	:	2625 REDWING RD STE 370
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6314
Country	:	US
Telephone Number	:	970-818-2004
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	05/28/2024

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