MEDICARE: NANCY LEE TWINING LCDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	15684	TX

General Provider Information

NPI Number	:	1407422744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY LEE TWINING LCDC

Provider Business Mailing Address
First Line	:	5805 64TH ST STE 1
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79424-2707
Country	:	US
Telephone Number	:	979-900-2525
Fax Number	:

Provider Business Practice Location Address
First Line	:	5805 64TH ST STE 1
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79424-2707
Country	:	US
Telephone Number	:	979-900-2525
Fax Number	:

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

Provider Enumeration Date	:	05/27/2021
Last Update Date	:	05/27/2021

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