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General NPI Number Information
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NPI Number | 1033419577
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Entity Type | Individual
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Provider Name | LISA WHITNEY SWANSON
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Gender | Female
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Dates
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Enumeration Date | 11/01/2010
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 2537 ASPEN AVE NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87104-1919
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Country | US
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Telephone | 505-206-5460
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Fax |
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Provider Business Mailing Address
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Address Line | 3301R COORS BLVD NW # 265
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-1229
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Country | US
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Telephone | 505-459-9301
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Fax | 505-884-1081
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0193841
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | T-0134911
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CCMH0193841
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License Number State | NM
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