MEDICARE: DR. DARRELL DUANE TURNER PHD

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	103TC0700X	Clinical Psychologist	6301008458	MI
2	103TC0700X	Clinical Psychologist	33078	TX
3	103TC0700X	Clinical Psychologist	071004216	IL

General Provider Information

NPI Number	:	1275633661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARRELL DUANE TURNER PHD

Provider Business Mailing Address
First Line	:	419 PRIMROSE LN
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-6766
Country	:	US
Telephone Number	:	713-435-9864
Fax Number	:	281-557-4737

Provider Business Practice Location Address
First Line	:	419 PRIMROSE LN
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-6766
Country	:	US
Telephone Number	:	713-435-9864
Fax Number	:	281-557-4737

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	04/03/2020

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