Healthcare Provider Details

I. General information

NPI: 1942659743
Provider Name (Legal Business Name): TWO SWANS COUNSELING SERVICE, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 SW D AVE STE 203
LAWTON OK
73501-4561
US

IV. Provider business mailing address

711 SW D AVE SUITE 203
LAWTON OK
73501-4561
US

V. Phone/Fax

Practice location:
  • Phone: 580-699-2011
  • Fax: 580-699-2012
Mailing address:
  • Phone: 580-699-2011
  • Fax: 580-699-2012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2468
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number914
License Number StateLA

VIII. Authorized Official

Name: MRS. JAMIE LYNN SWANSON
Title or Position: OWNER/THERAPIST
Credential: MS, LPC
Phone: 580-699-2011