Healthcare Provider Details

I. General information

NPI: 1518836907
Provider Name (Legal Business Name): MICHAEL ROBERT TOM TURNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 EL RANCHO RD
EVERGREEN CO
80439-8238
US

IV. Provider business mailing address

11447 BROOMFIELD LN UNIT 204
BROOMFIELD CO
80021-7906
US

V. Phone/Fax

Practice location:
  • Phone: 720-295-3790
  • Fax:
Mailing address:
  • Phone: 571-265-9649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-467458
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: