Provider Demographics
NPI:1639822091
Name:TURK, TERRY DORON JR
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:DORON
Last Name:TURK
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:
Other - Last Name:MASTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:503 E 200TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1562
Mailing Address - Country:US
Mailing Address - Phone:216-272-1083
Mailing Address - Fax:
Practice Address - Street 1:503 E 200TH ST STE 103
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-1562
Practice Address - Country:US
Practice Address - Phone:216-272-1083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor