Provider Demographics
NPI:1457656431
Name:TURNER MAXWELL, MARY-VIRGINIA
Entity Type:Individual
Prefix:MS
First Name:MARY-VIRGINIA
Middle Name:
Last Name:TURNER MAXWELL
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 1:501 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3550
Mailing Address - Country:US
Mailing Address - Phone:509-494-6700
Mailing Address - Fax:509-573-6275
Practice Address - Street 1:314 S 11TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3212
Practice Address - Country:US
Practice Address - Phone:509-575-0114
Practice Address - Fax:509-575-0808
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60153235101YM0800X
WALH60483238101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2037774Medicaid
WA2037774Medicaid