Provider Demographics
NPI:1497583934
Name:TURNER, NICOLE (PPS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:TURNER
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PPS
Mailing Address - Street 1:103 NOBEL AVE
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-9734
Mailing Address - Country:US
Mailing Address - Phone:209-996-1398
Mailing Address - Fax:
Practice Address - Street 1:6250 SCOTTS CREEK DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-7244
Practice Address - Country:US
Practice Address - Phone:209-953-9302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230029297101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool