=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992014856
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DESIREE TURNER THERAPEUTIC SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2010
-----------------------------------------------------
Last Update Date | 09/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1302 N I ST
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98403-2118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-921-9589
-----------------------------------------------------
Fax | 253-272-3348
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1302 N I ST
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98403-2118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-921-9589
-----------------------------------------------------
Fax | 253-272-3348
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MS. DESIREE DEE TURNER
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 253-921-9589
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------