Provider Demographics
NPI:1285918797
Name:TWILLEY, JENNIFER DIANNE (LMFT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DIANNE
Last Name:TWILLEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 MINNETONGA TRL
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-8369
Mailing Address - Country:US
Mailing Address - Phone:940-217-5810
Mailing Address - Fax:
Practice Address - Street 1:590 MINNETONGA TRL
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-8369
Practice Address - Country:US
Practice Address - Phone:402-175-8109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204279106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist