Provider Demographics
NPI:1154497550
Name:TWIST, MICHELE (LPC LMFT LCDC)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:TWIST
Suffix:
Gender:F
Credentials:LPC LMFT LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 GARDENDALE #601
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-219-4817
Mailing Address - Fax:
Practice Address - Street 1:4230 GARDENDALE ST STE 601
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3482
Practice Address - Country:US
Practice Address - Phone:210-219-4817
Practice Address - Fax:210-736-4456
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2845101YA0400X
TX003090042688106H00000X
TX10769101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX027272601Medicaid