MEDICARE: SWICK CLINICAL SERVICES INC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L8208	OTHER	OR	OBLSW LICENSURE
2	19-10-29	OTHER	OR	MHACBO CADC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598344590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWICK CLINICAL SERVICES INC

Provider Business Mailing Address
First Line	:	PO BOX 7964
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97708-7964
Country	:	US
Telephone Number	:	541-241-6123
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 NW FRANKLIN AVE
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-2905
Country	:	US
Telephone Number	:	541-241-6123
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST/OWNER
Name	:	MR. PETER CHARLES SWICK
Credential	:	LCSW
Telephone Number	:	458-600-6101

Provider Enumeration Date	:	04/06/2021
Last Update Date	:	09/10/2021

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Directions to “SWICK CLINICAL SERVICES INC ” Practice Location

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