Provider Demographics
NPI:1881467041
Name:TURNER, JIMMIE RICHARD (PHD)
Entity type:Individual
Prefix:
First Name:JIMMIE
Middle Name:RICHARD
Last Name:TURNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-3832
Mailing Address - Country:US
Mailing Address - Phone:510-435-1433
Mailing Address - Fax:
Practice Address - Street 1:857 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-3832
Practice Address - Country:US
Practice Address - Phone:510-435-1433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6917103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical