MEDICARE: MR. IRA T TURNER II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1164385332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IRA T TURNER II

Provider Business Mailing Address
First Line	:	41 BUTTONWORTH DR
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-3507
Country	:	US
Telephone Number	:	904-508-2802
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 BUTTONWORTH DR
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-3507
Country	:	US
Telephone Number	:	904-508-2802
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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