Healthcare Provider Details

I. General information

NPI: 1598348419
Provider Name (Legal Business Name): GRACE SWANK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 STATE ST
SANTA BARBARA CA
93101-3329
US

IV. Provider business mailing address

25402 PACIFICA AVE
MISSION VIEJO CA
92691-3854
US

V. Phone/Fax

Practice location:
  • Phone: 805-697-4488
  • Fax:
Mailing address:
  • Phone: 949-238-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163871
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: