Healthcare Provider Details

I. General information

NPI: 1326415209
Provider Name (Legal Business Name): MARY TURNER MSW LCSW CCDP-D LLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 E KINGSLEY ST STE C
SPRINGFIELD MO
65804-7238
US

IV. Provider business mailing address

1310 E KINGSLEY ST STE C
SPRINGFIELD MO
65804-7238
US

V. Phone/Fax

Practice location:
  • Phone: 417-862-3455
  • Fax: 417-862-9771
Mailing address:
  • Phone: 417-882-7700
  • Fax: 417-882-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2011034998
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: