Healthcare Provider Details

I. General information

NPI: 1720183262
Provider Name (Legal Business Name): STEPHEN LEE SWENDER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E 20TH ST
HOPE AR
71801-8217
US

IV. Provider business mailing address

2904 ARKANSAS BLVD
TEXARKANA AR
71854-2536
US

V. Phone/Fax

Practice location:
  • Phone: 870-777-9051
  • Fax: 870-777-3104
Mailing address:
  • Phone: 870-773-4655
  • Fax: 870-771-4650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number06-21P
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number007756091
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: