MEDICARE: MYRACLE LAVETTA TURNER

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1417802562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYRACLE LAVETTA TURNER

Provider Business Mailing Address
First Line	:	3815 W MORTEN AVE # 85051
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-6455
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3815 W MORTEN AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-6455
Country	:	US
Telephone Number	:	414-617-3095
Fax Number	:

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

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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Directions to “ MYRACLE LAVETTA TURNER ” Practice Location

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