Provider Demographics
NPI:1952883134
Name:TWIEST, JOSHUA (LLC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:TWIEST
Suffix:
Gender:M
Credentials:LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 LAMOREAUX DR NE
Mailing Address - Street 2:
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-9115
Mailing Address - Country:US
Mailing Address - Phone:616-490-3324
Mailing Address - Fax:
Practice Address - Street 1:11630 FULTON ST E
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-9426
Practice Address - Country:US
Practice Address - Phone:616-481-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016710101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor