Provider Demographics
NPI:1477216778
Name:TWOHIG, MICHAEL PETER
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PETER
Last Name:TWOHIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N 1500 E
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4355
Mailing Address - Country:US
Mailing Address - Phone:435-752-5008
Mailing Address - Fax:
Practice Address - Street 1:900 N 1500 E
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4355
Practice Address - Country:US
Practice Address - Phone:435-265-8933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7311791-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist