Healthcare Provider Details

I. General information

NPI: 1699237164
Provider Name (Legal Business Name): MARK D TURNEYMFT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5053 LA MART DR STE 207
RIVERSIDE CA
92507-5990
US

IV. Provider business mailing address

5053 LA MART DR STE 207
RIVERSIDE CA
92507-5990
US

V. Phone/Fax

Practice location:
  • Phone: 951-784-7640
  • Fax:
Mailing address:
  • Phone: 951-784-7640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARK D TURNEY
Title or Position: PRESIDENT
Credential: LMFT
Phone: 951-214-5727