Healthcare Provider Details

I. General information

NPI: 1659113017
Provider Name (Legal Business Name): BENJAMIN SWANK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 THREE SPRINGS BLVD
DURANGO CO
81301-9033
US

IV. Provider business mailing address

PO BOX 1328
DURANGO CO
81302-1328
US

V. Phone/Fax

Practice location:
  • Phone: 970-403-0180
  • Fax: 970-403-0190
Mailing address:
  • Phone: 970-403-0180
  • Fax: 970-403-0190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC.0022259
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: