Basic Information
| Provider Information | |||||||||
| NPI: | 1295942258 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TURNER | ||||||||
| FirstName: | TYRIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CACII | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1355 BAGLEY ST | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482261004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139656065 | ||||||||
| FaxNumber: | 3138670706 | ||||||||
| Practice Location | |||||||||
| Address1: | 12010 LINWOOD ST | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482061108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138671090 | ||||||||
| FaxNumber: | 3138670706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.