MEDICARE: CAROL A SWANSON LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LMFT98745	CA

General Provider Information

NPI Number	:	1285906958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL A SWANSON LMFT

Provider Business Mailing Address
First Line	:	3727 SUNSET LN
Second Line	:	STE 210
City	:	ANTIOCH
State	:	CA
Zip	:	94509-6134
Country	:	US
Telephone Number	:	925-753-2156
Fax Number	:	925-753-2157

Provider Business Practice Location Address
First Line	:	4710 AUTUMN MEADOW DR
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94534-3994
Country	:	US
Telephone Number	:	707-688-5539
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2012
Last Update Date	:	02/05/2018

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