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General NPI Number Information
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NPI Number | 1952883134
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Entity Type | Individual
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Provider Name | JOSHUA TWIEST LLC
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Gender | Male
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Dates
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Enumeration Date | 09/04/2018
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Last Update Date | 09/04/2018
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Provider Practice Location Address
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Address Line | 11630 FULTON ST E
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City | LOWELL
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State | MI
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Zip | 49331-9426
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Country | US
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Telephone | 616-481-3784
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Fax |
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Provider Business Mailing Address
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Address Line | 95 LAMOREAUX DR NE
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City | COMSTOCK PARK
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State | MI
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Zip | 49321-9115
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Country | US
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Telephone | 616-490-3324
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401016710
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License Number State | MI
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