Provider Demographics
NPI:1740408533
Name:TURKLE, IAN I (LCMHC)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:I
Last Name:TURKLE
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-1732
Mailing Address - Country:US
Mailing Address - Phone:802-673-5523
Mailing Address - Fax:
Practice Address - Street 1:194 MAIN ST
Practice Address - Street 2:SUITE 220
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-6104
Practice Address - Country:US
Practice Address - Phone:802-673-5523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000678101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT600013553OtherMAGELLAN
VT0069405OtherBLUE CROSS BLUE SHIELD VT
VT1012711Medicaid
VT2304422OtherCIGNA
VT4149804OtherMVP