Basic Information
| Provider Information | |||||||||
| NPI: | 1740847755 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TWILLMAN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | KEITH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13124 W 83RD TER | ||||||||
| Address2: | |||||||||
| City: | LENEXA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662152824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9132053746 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4225 BALTIMORE AVE | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641112304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169321711 | ||||||||
| FaxNumber: | 8169321719 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2019 | ||||||||
| LastUpdateDate: | 08/09/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | LP-789 | KS | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103T00000X | 2019030582 | MO | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.