Healthcare Provider Details

I. General information

NPI: 1104637016
Provider Name (Legal Business Name): JUDY REBECCA TURNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 BOWMAN AVE
MORAINE OH
45409-1521
US

IV. Provider business mailing address

1629 BOWMAN AVE
MORAINE OH
45409-1521
US

V. Phone/Fax

Practice location:
  • Phone: 937-672-9596
  • Fax:
Mailing address:
  • Phone: 937-672-9596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.192356
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.005968
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: