Healthcare Provider Details

I. General information

NPI: 1144133778
Provider Name (Legal Business Name): CAL TWITTY II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 STANFORD CT STE 602
NAPLES FL
34112-4841
US

IV. Provider business mailing address

3728 TARECO ST
FORT MYERS FL
33905-5700
US

V. Phone/Fax

Practice location:
  • Phone: 239-537-9646
  • Fax:
Mailing address:
  • Phone: 239-537-9646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH29706
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: