Provider Demographics
NPI:1407251945
Name:TURNER, MITCHELL ISAAC (LPC, SAC-IT)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:ISAAC
Last Name:TURNER
Suffix:
Gender:M
Credentials:LPC, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 W BELTLINE HWY # 185
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2679
Mailing Address - Country:US
Mailing Address - Phone:608-960-4726
Mailing Address - Fax:608-729-3774
Practice Address - Street 1:313 W BELTLINE HWY # 185
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-2679
Practice Address - Country:US
Practice Address - Phone:608-960-4726
Practice Address - Fax:608-729-3774
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7290125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1407251945Medicaid