Healthcare Provider Details

I. General information

NPI: 1164363495
Provider Name (Legal Business Name): SWG AUTISM SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9615 AVENIDA DE LA LUNA NE
ALBUQUERQUE NM
87111-1603
US

IV. Provider business mailing address

9615 AVENIDA DE LA LUNA NE
ALBUQUERQUE NM
87111-1603
US

V. Phone/Fax

Practice location:
  • Phone: 505-401-5086
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: SHANNON SCHUM
Title or Position: OWNER
Credential:
Phone: 505-401-5086