Healthcare Provider Details

I. General information

NPI: 1679162200
Provider Name (Legal Business Name): JENNIFER SWANSON COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
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 TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER SWANSON
Title or Position: OWNER
Credential: LMHC
Phone: 406-565-1886