Healthcare Provider Details

I. General information

NPI: 1891475232
Provider Name (Legal Business Name): KAYLA MARIE SWANSON LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 TECHNOLOGY PARK STE 109
LAKE MARY FL
32746-7107
US

IV. Provider business mailing address

2400 S RIDGEWOOD AVE STE 32
SOUTH DAYTONA FL
32119-3073
US

V. Phone/Fax

Practice location:
  • Phone: 407-647-2346
  • Fax:
Mailing address:
  • Phone: 850-570-0420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH27941
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: