=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700713641
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SEAN TERWILLIGER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2026
-----------------------------------------------------
Last Update Date | 05/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1523 LONGBRANCH AVE
-----------------------------------------------------
City | GROVER BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93433-2508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-473-7006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 KERN AVE
-----------------------------------------------------
City | MORRO BAY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93442-2807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------