Provider Demographics
NPI:1558996629
Name:TURNER, AMANDA LOIS
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LOIS
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 1:3 DONALD CT
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5618
Mailing Address - Country:US
Mailing Address - Phone:630-921-2898
Mailing Address - Fax:
Practice Address - Street 1:2100 RIDGE AVE # G320
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-2716
Practice Address - Country:US
Practice Address - Phone:630-921-2898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor