Provider Demographics
NPI:1669187688
Name:AXELSON, TWYLA MICHELLE
Entity type:Individual
Prefix:
First Name:TWYLA
Middle Name:MICHELLE
Last Name:AXELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TWYLA
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-A, MA
Mailing Address - Street 1:5413 SOLEDAD DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-6035
Mailing Address - Country:US
Mailing Address - Phone:469-215-0947
Mailing Address - Fax:
Practice Address - Street 1:8951 CYPRESS WATERS BLVD STE 160
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4784
Practice Address - Country:US
Practice Address - Phone:469-607-0076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90620101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional