Provider Demographics
NPI:1417386426
Name:TURK, JEREMY DAVID
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:DAVID
Last Name:TURK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65806-2754
Mailing Address - Country:US
Mailing Address - Phone:417-773-0853
Mailing Address - Fax:
Practice Address - Street 1:815 S ASH ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-3222
Practice Address - Country:US
Practice Address - Phone:417-667-8352
Practice Address - Fax:417-667-9216
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor