Provider Demographics
NPI:1982172235
Name:MARY C. TURNER MSW LCSW CCDP-D, LLC
Entity Type:Organization
Organization Name:MARY C. TURNER MSW LCSW CCDP-D, LLC
Other - Org Name:FAMILY THERAPY OF THE OZARKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MSW, CCDPD
Authorized Official - Phone:417-882-7700
Mailing Address - Street 1:1310 E. KINGSLEY ST. C
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7216
Mailing Address - Country:US
Mailing Address - Phone:417-882-7700
Mailing Address - Fax:417-885-3956
Practice Address - Street 1:1310 E. KINGSLEY ST. C
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7216
Practice Address - Country:US
Practice Address - Phone:417-882-7700
Practice Address - Fax:417-885-3956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490052454Medicaid