MEDICARE: NICOLE MARIE TWENTER LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2019035900	MO

General Provider Information

NPI Number	:	1023781564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARIE TWENTER LPC

Provider Business Mailing Address
First Line	:	11295 N HWY
Second Line	:
City	:	PILOT GROVE
State	:	MO
Zip	:	65276-2310
Country	:	US
Telephone Number	:	660-621-4451
Fax Number	:

Provider Business Practice Location Address
First Line	:	1195 N OAKLAND AVE
Second Line	:
City	:	BOLIVAR
State	:	MO
Zip	:	65613-8095
Country	:	US
Telephone Number	:	660-621-4451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2021
Last Update Date	:	07/30/2021

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Directions to “ NICOLE MARIE TWENTER LPC” Practice Location

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