Provider Demographics
NPI:1245061639
Name:TURNER, CHRISTY RENE (LAC, LSW)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:RENE
Last Name:TURNER
Suffix:
Gender:F
Credentials:LAC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-1040
Mailing Address - Country:US
Mailing Address - Phone:719-423-9905
Mailing Address - Fax:
Practice Address - Street 1:1624 BONFORTE BLVD STE D
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1680
Practice Address - Country:US
Practice Address - Phone:719-320-6201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.00022539101YA0400X
COLSW.00099244061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)