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General NPI Number Information
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NPI Number | 1356068217
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Entity Type | Individual
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Provider Name | SAMANTHA SWAFFORD MS, LPCC
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Gender | Female
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Dates
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Enumeration Date | 10/21/2022
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Last Update Date | 10/21/2022
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Provider Practice Location Address
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Address Line | 10000 HWY 55 STE 300
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City | PLYMOUTH
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State | MN
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Zip | 55441-6389
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Country | US
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Telephone | 763-412-0722
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Fax | 763-600-6707
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Provider Business Mailing Address
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Address Line | 10000 HWY 55 STE 300
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City | PLYMOUTH
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State | MN
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Zip | 55441-6389
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Country | US
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Telephone | 763-412-0722
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Fax | 763-600-6707
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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 | 3540
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License Number State | MN
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