Healthcare Provider Details

I. General information

NPI: 1760932545
Provider Name (Legal Business Name): TARA D TURNER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 WYOMING ST
MISSOULA MT
59801-1725
US

IV. Provider business mailing address

1305 WYOMING ST
MISSOULA MT
59801-1725
US

V. Phone/Fax

Practice location:
  • Phone: 406-532-9770
  • Fax: 406-541-3034
Mailing address:
  • Phone: 406-546-4796
  • Fax: 406-541-3034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-LCSW-LIC-19308
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: