Provider Demographics
NPI:1225546120
Name:TURNER, TAVIA (RMA)
Entity Type:Individual
Prefix:
First Name:TAVIA
Middle Name:
Last Name:TURNER
Suffix:
Gender:F
Credentials:RMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18758 FLORENCE ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4816
Mailing Address - Country:US
Mailing Address - Phone:313-740-6084
Mailing Address - Fax:
Practice Address - Street 1:18758 FLORENCE ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4816
Practice Address - Country:US
Practice Address - Phone:313-740-6084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-14
Last Update Date:2018-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI58966997Medicaid