MEDICARE: TURQUOISE BANKS

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	101YP2500X	Professional Counselor	79497	TX

General Provider Information

NPI Number	:	1821629957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TURQUOISE BANKS

Provider Business Mailing Address
First Line	:	5821 WEDGWOOD DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-2726
Country	:	US
Telephone Number	:	432-349-1870
Fax Number	:

Provider Business Practice Location Address
First Line	:	5821 WEDGWOOD DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-2726
Country	:	US
Telephone Number	:	432-349-1870
Fax Number	:

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

Provider Enumeration Date	:	01/28/2020
Last Update Date	:	01/28/2020

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Directions to “ TURQUOISE BANKS ” Practice Location

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