=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275584955
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TWILA PICKRELL LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2006
-----------------------------------------------------
Last Update Date | 05/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 909 NE LOOP 410 STE 730
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78209-1303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-305-0444
-----------------------------------------------------
Fax | 210-804-1887
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 909 NE LOOP 410 STE 730
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78209-1303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-305-0444
-----------------------------------------------------
Fax | 210-804-1887
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 32426
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------