Healthcare Provider Details

I. General information

NPI: 1104230986
Provider Name (Legal Business Name): DERRICK JULIAN TURNER MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 08/17/2025
Certification Date: 08/17/2025
Deactivation Date: 10/13/2022
Reactivation Date: 10/24/2022

III. Provider practice location address

738 S FRED SHUTTLESWORTH CIR
CINCINNATI OH
45229-2113
US

IV. Provider business mailing address

738 S FRED SHUTTLESWORTH CIR
CINCINNATI OH
45229-2113
US

V. Phone/Fax

Practice location:
  • Phone: 216-374-9514
  • Fax:
Mailing address:
  • Phone: 216-374-9514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.027598
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: