Healthcare Provider Details

I. General information

NPI: 1174030126
Provider Name (Legal Business Name): JOEY TURNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 12/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9641 HARPER AVE
DETROIT MI
48213-2731
US

IV. Provider business mailing address

4471 HIGH ST APT 22
ECORSE MI
48229-1465
US

V. Phone/Fax

Practice location:
  • Phone: 313-883-7246
  • Fax:
Mailing address:
  • Phone: 734-845-6466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: