Provider Demographics
NPI:1548905862
Name:PORTER TURNER, KELLEY ROXANNE (LMSW)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:ROXANNE
Last Name:PORTER TURNER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 N CENTRAL AVE STE 550
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2635
Mailing Address - Country:US
Mailing Address - Phone:602-230-7373
Mailing Address - Fax:602-682-7455
Practice Address - Street 1:3330 N 2ND ST STE 601
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2395
Practice Address - Country:US
Practice Address - Phone:602-230-7373
Practice Address - Fax:602-230-5105
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPENDING1041C0700X
AZLMSW-20785104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNMSWOtherWALDEN UNIVERSITY
AZLMSW-20785OtherARIZONA BOARD OF BEHAVIORAL HEALTH