Healthcare Provider Details

I. General information

NPI: 1164388906
Provider Name (Legal Business Name): MR. JAMICHAEL ANTONIO TURNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4780 I 55 N
JACKSON MS
39211-5542
US

IV. Provider business mailing address

4780 I 55 N
JACKSON MS
39211-5542
US

V. Phone/Fax

Practice location:
  • Phone: 318-516-3801
  • Fax: 504-389-1151
Mailing address:
  • Phone: 318-516-3801
  • Fax: 504-389-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: