Healthcare Provider Details

I. General information

NPI: 1639001589
Provider Name (Legal Business Name): TIMOTHY J. SWANSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1826 E PLATTE AVE STE 102
COLORADO SPRINGS CO
80909-5738
US

IV. Provider business mailing address

1826 E PLATTE AVE STE 102
COLORADO SPRINGS CO
80909-5738
US

V. Phone/Fax

Practice location:
  • Phone: 719-358-6559
  • Fax: 719-418-3728
Mailing address:
  • Phone: 719-358-6559
  • Fax: 719-418-3728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY SWANSON
Title or Position: OWNER
Credential:
Phone: 719-358-6559