Basic Information
Provider Information
NPI: 1992868798
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TURNER
FirstName: TRACY
MiddleName: YVONNE
NamePrefix:  
NameSuffix:  
Credential: MSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 517 NE OLYMPIC CT
Address2:  
City: LEES SUMMIT
State: MO
PostalCode: 640641306
CountryCode: US
TelephoneNumber: 8163507077
FaxNumber:  
Practice Location
Address1: 3801 BLUE PKWY
Address2:  
City: KANSAS CITY
State: MO
PostalCode: 641302807
CountryCode: US
TelephoneNumber: 8169227645
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/19/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X2007014403MOY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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