Provider Demographics
NPI:1710588520
Name:TWESTEN, JANICE MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:MARIE
Last Name:TWESTEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 BURTON ST SE STE 101
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-4800
Mailing Address - Country:US
Mailing Address - Phone:616-309-0737
Mailing Address - Fax:
Practice Address - Street 1:7066 COUNTRY SPRINGS DR SW
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-8129
Practice Address - Country:US
Practice Address - Phone:616-545-8169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101007002106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty