MEDICARE: BLAKE 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	101Y00000X	Counselor
2	1041C0700X	Clinical Social Worker	11256817-3502	UT

General Provider Information

NPI Number	:	1598245425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLAKE TURNER

Provider Business Mailing Address
First Line	:	1030 UNIVERSITY VLG
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-3452
Country	:	US
Telephone Number	:	435-232-8363
Fax Number	:

Provider Business Practice Location Address
First Line	:	2621 S 3270 W
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-1119
Country	:	US
Telephone Number	:	801-412-6920
Fax Number	:	801-982-9232

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

Provider Enumeration Date	:	08/20/2018
Last Update Date	:	06/09/2019

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Directions to “ BLAKE TURNER ” Practice Location

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