Healthcare Provider Details

I. General information

NPI: 1427440205
Provider Name (Legal Business Name): WILLIE TURNER JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 N CEDAR AVE 108
FRESNO CA
93726-2538
US

IV. Provider business mailing address

4411 N CEDAR AVE 108
FRESNO CA
93726-2538
US

V. Phone/Fax

Practice location:
  • Phone: 559-248-1548
  • Fax: 559-248-1530
Mailing address:
  • Phone: 559-248-1548
  • Fax: 559-248-1530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number200009AN
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: