Healthcare Provider Details

I. General information

NPI: 1134619216
Provider Name (Legal Business Name): STACY TURGEON RBT-17-46723
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 06/22/2023
Certification Date: 06/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EVANS ARMY COMMUNITY HOSPITAL, 1650 COCHRANE CIR B7500
FT CARSON CO
80913
US

IV. Provider business mailing address

EVANS ARMY COMMUNITY HOSPITAL, 1650 COCHRANE CIR B7500
FT CARSON CO
80913
US

V. Phone/Fax

Practice location:
  • Phone: 586-216-2089
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number17-46723
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: