Healthcare Provider Details

I. General information

NPI: 1467017657
Provider Name (Legal Business Name): JENNIFER SWANSON MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1294 SE 24TH RD
OCALA FL
34471-6010
US

IV. Provider business mailing address

1294 SE 24TH RD
OCALA FL
34471-6010
US

V. Phone/Fax

Practice location:
  • Phone: 406-565-1886
  • Fax:
Mailing address:
  • Phone: 406-565-1886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-LCPC-LIC-38063
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17496
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: