MEDICARE: DR. JACKSON E TURNER JR. PH.D.

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	6301008377	MI

General Provider Information

NPI Number	:	1316060114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACKSON E TURNER JR. PH.D.

Provider Business Mailing Address
First Line	:	30425 LEEMOOR ST
Second Line	:
City	:	BEVERLY HILLS
State	:	MI
Zip	:	48025-4916
Country	:	US
Telephone Number	:	248-514-6476
Fax Number	:	248-369-6389

Provider Business Practice Location Address
First Line	:	2525 CROOKS RD STE 100
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48084-4733
Country	:	US
Telephone Number	:	248-731-7305
Fax Number	:	248-731-7388

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

Provider Enumeration Date	:	04/08/2007
Last Update Date	:	08/02/2018

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