Provider Demographics
NPI:1275394132
Name:TWIGG, AMBER K (MC, LAC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:K
Last Name:TWIGG
Suffix:
Gender:F
Credentials:MC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37121 N CAMPOLINA RD
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-1735
Mailing Address - Country:US
Mailing Address - Phone:503-707-6861
Mailing Address - Fax:
Practice Address - Street 1:37121 N CAMPOLINA RD
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-1735
Practice Address - Country:US
Practice Address - Phone:503-707-6861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-22523101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional