Healthcare Provider Details

I. General information

NPI: 1043396385
Provider Name (Legal Business Name): TWYLA MCGUIRE HERSMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 UNDERCLIFF TER
PRINCETON WV
24740-2174
US

IV. Provider business mailing address

160 UNDERCLIFF TER
PRINCETON WV
24740-2174
US

V. Phone/Fax

Practice location:
  • Phone: 304-425-6110
  • Fax: 304-487-6199
Mailing address:
  • Phone: 304-425-6110
  • Fax: 304-487-6199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number136
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: