Healthcare Provider Details

I. General information

NPI: 1215300447
Provider Name (Legal Business Name): SWANSON PSYCHOTHERAPY, P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 11/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S ALLEN ST 318B
STATE COLLEGE PA
16801-4849
US

IV. Provider business mailing address

315 S ALLEN ST 318B
STATE COLLEGE PA
16801-4849
US

V. Phone/Fax

Practice location:
  • Phone: 814-574-2939
  • Fax:
Mailing address:
  • Phone: 814-574-2939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPC004788
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. DEANNE LOUISE SWANSON
Title or Position: PSYCHOLOGIST
Credential: LPC
Phone: 814-574-2939