Healthcare Provider Details

I. General information

NPI: 1871403642
Provider Name (Legal Business Name): PAUL SWANSON JR. LMHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 E FOXBOROUGH CT
HAYDEN ID
83835-9383
US

IV. Provider business mailing address

2025 E FOXBOROUGH CT
HAYDEN ID
83835-9383
US

V. Phone/Fax

Practice location:
  • Phone: 509-780-6178
  • Fax:
Mailing address:
  • Phone: 509-780-6178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.70147923
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: