Provider Demographics
NPI:1689822777
Name:TWIST, NANCY M (MFT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:TWIST
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80562
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91118-8562
Mailing Address - Country:US
Mailing Address - Phone:626-932-1009
Mailing Address - Fax:
Practice Address - Street 1:521 1/2 S MYRTLE AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-5189
Practice Address - Country:US
Practice Address - Phone:626-932-1009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43299106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist