Basic Information
| Provider Information | |||||||||
| NPI: | 1902045263 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHERBOURNE | ||||||||
| FirstName: | TWYLA | ||||||||
| MiddleName: | EYVONNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4238 SCHWYHART LN | ||||||||
| Address2: | |||||||||
| City: | OROVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959659779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305328796 | ||||||||
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| Practice Location | |||||||||
| Address1: | 107 PARMAC RD | ||||||||
| Address2: | STE 2 | ||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959262298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308912784 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2009 | ||||||||
| LastUpdateDate: | 02/10/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.