Provider Demographics
NPI:1598910507
Name:TURNER, WORAWAN C (PSYD, LP)
Entity Type:Individual
Prefix:
First Name:WORAWAN
Middle Name:C
Last Name:TURNER
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 VERNON AVE S
Mailing Address - Street 2:SUITE 212
Mailing Address - City:ST. LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4021 VERNON AVE S
Practice Address - Street 2:SUITE 212
Practice Address - City:ST. LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2801
Practice Address - Country:US
Practice Address - Phone:952-222-4491
Practice Address - Fax:952-222-4492
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4984103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH100220283OtherMEDICARE PTAN