Healthcare Provider Details

I. General information

NPI: 1447429188
Provider Name (Legal Business Name): D'ARCY SWANSON INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 SW 13TH ST SUITE #100
BEND OR
97702-3184
US

IV. Provider business mailing address

19928 SW HOLLYGRAPE ST
BEND OR
97702-2575
US

V. Phone/Fax

Practice location:
  • Phone: 541-419-3947
  • Fax:
Mailing address:
  • Phone: 541-419-3947
  • Fax: 541-317-9757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC1803
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC1803
License Number StateOR

VIII. Authorized Official

Name: MR. D'ARCY BENEDICT SWANSON
Title or Position: PRESIDENT
Credential: M.C., L.P,C.
Phone: 541-419-3947