Provider Demographics
NPI:1750443453
Name:TWYMAN, JEFFREY (LMFT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:TWYMAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2044 DOUGLASS BLVD # 2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1928
Mailing Address - Country:US
Mailing Address - Phone:502-599-9181
Mailing Address - Fax:
Practice Address - Street 1:2044 DOUGLASS BLVD # 2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1928
Practice Address - Country:US
Practice Address - Phone:502-599-9181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY105117106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY105117OtherKY BOARD OF LICENSURE FOR MARRIAGE AND FAMILY THERAPISTS