Provider Demographics
NPI:1972888246
Name:TWITCHELL, JORY
Entity type:Individual
Prefix:
First Name:JORY
Middle Name:
Last Name:TWITCHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6484 N 2300 W
Mailing Address - Street 2:6484 N. 2300 W.
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-7102
Mailing Address - Country:US
Mailing Address - Phone:435-867-4876
Mailing Address - Fax:
Practice Address - Street 1:6484 N 2300 W
Practice Address - Street 2:6484 N. 2300 W.
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-7102
Practice Address - Country:US
Practice Address - Phone:435-867-4876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children