Provider Demographics
NPI:1174367825
Name:TWIN RIVERS MENTAL HEALTH
Entity type:Organization
Organization Name:TWIN RIVERS MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEI
Authorized Official - Middle Name:
Authorized Official - Last Name:FALLER
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, FNP-BC
Authorized Official - Phone:386-319-0709
Mailing Address - Street 1:215 HOWARD ST W
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-2303
Mailing Address - Country:US
Mailing Address - Phone:386-319-0709
Mailing Address - Fax:855-616-8455
Practice Address - Street 1:215 HOWARD ST W
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-2303
Practice Address - Country:US
Practice Address - Phone:386-319-0709
Practice Address - Fax:855-616-8455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-19
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty