Provider Demographics
NPI:1407204167
Name:TURNER, BREANNA
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:TURNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N CLOVIS AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612
Mailing Address - Country:US
Mailing Address - Phone:559-549-3915
Mailing Address - Fax:
Practice Address - Street 1:150 N CLOVIS AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-5922
Practice Address - Country:US
Practice Address - Phone:559-549-3915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CAIMF93000106H00000X
CA112470106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist