Provider Demographics
NPI:1275584955
Name:PICKRELL, TWILA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TWILA
Middle Name:
Last Name:PICKRELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 NE LOOP 410 STE 730
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1303
Mailing Address - Country:US
Mailing Address - Phone:210-305-0444
Mailing Address - Fax:210-804-1887
Practice Address - Street 1:909 NE LOOP 410 STE 730
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1303
Practice Address - Country:US
Practice Address - Phone:210-305-0444
Practice Address - Fax:210-804-1887
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX324261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149705901Medicaid
TX32426OtherTX LCSW
TX32426OtherTX LCSW