MEDICARE: PAIGE SWANSON

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor	88666	TX

General Provider Information

NPI Number	:	1629626031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAIGE SWANSON

Provider Business Mailing Address
First Line	:	4514 COLE AVE # 601
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-5412
Country	:	US
Telephone Number	:	210-478-7567
Fax Number	:

Provider Business Practice Location Address
First Line	:	729 N BISHOP AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-4340
Country	:	US
Telephone Number	:	210-478-7567
Fax Number	:

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

Provider Enumeration Date	:	08/28/2019
Last Update Date	:	04/28/2023

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Directions to “ PAIGE SWANSON ” Practice Location

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