Healthcare Provider Details

I. General information

NPI: 1184857120
Provider Name (Legal Business Name): LAURA JONES SWANN MED., LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 08/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E DEAN KEETON ST
AUSTIN TX
78712-1043
US

IV. Provider business mailing address

100 WEST DEAN KEETON
AUSTIN TX
78712
US

V. Phone/Fax

Practice location:
  • Phone: 521-475-8352
  • Fax: 512-475-8459
Mailing address:
  • Phone: 512-475-8352
  • Fax: 512-475-8459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4752
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: