MEDICARE: TWYLA ROSE & CO, PLLC

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
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1164258760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWYLA ROSE & CO, PLLC

Provider Business Mailing Address
First Line	:	43996 WOODWARD AVE STE 5
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-5049
Country	:	US
Telephone Number	:	248-876-3893
Fax Number	:

Provider Business Practice Location Address
First Line	:	43996 WOODWARD AVE STE 5
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-5049
Country	:	US
Telephone Number	:	248-876-3893
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST/OWNER
Name	:	TWYLA MALCOM
Credential	:	LPC, NCC
Telephone Number	:	248-949-0681

Provider Enumeration Date	:	09/10/2024
Last Update Date	:	09/10/2024

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