Provider Demographics
NPI:1982700522
Name:GALVAN TURNER, MANETTE (LCPC)
Entity Type:Individual
Prefix:
First Name:MANETTE
Middle Name:
Last Name:GALVAN TURNER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 W ROOSEVELT RD
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5087
Mailing Address - Country:US
Mailing Address - Phone:630-462-3999
Mailing Address - Fax:
Practice Address - Street 1:610 W ROOSEVELT RD
Practice Address - Street 2:SUITE B-1
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5087
Practice Address - Country:US
Practice Address - Phone:630-462-3999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2273064OtherBLUE CROSS BLUE SHIELD