Provider Demographics
NPI:1841331683
Name:PRESTON, TWILA L (PHD)
Entity type:Individual
Prefix:
First Name:TWILA
Middle Name:L
Last Name:PRESTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8014 STATE LINE RD
Mailing Address - Street 2:100
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3723
Mailing Address - Country:US
Mailing Address - Phone:913-432-2400
Mailing Address - Fax:913-432-2401
Practice Address - Street 1:8014 STATE LINE RD
Practice Address - Street 2:100
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3723
Practice Address - Country:US
Practice Address - Phone:913-432-2400
Practice Address - Fax:913-432-2401
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE531103TC0700X
KS2241103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE74306484826Medicaid
NE08406OtherBCBSNE
NE74306484826Medicaid