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General NPI Number Information
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NPI Number | 1467844712
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Entity Type | Organization
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Legal Business Name | JA SWANSON LICENSED CLINICAL PSYCHOLOGIST, PLLC
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Dates
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Enumeration Date | 02/24/2015
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Last Update Date | 05/12/2023
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Provider Practice Location Address
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Address Line | 19200 SPACE CENTER BLVD
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City | HOUSTON
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State | TX
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Zip | 77058-3736
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Country | US
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Telephone | 281-626-7986
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Fax | 281-688-1888
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Provider Business Mailing Address
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Address Line | 957 NASA PKWY # 1106
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City | HOUSTON
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State | TX
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Zip | 77058-3039
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Country | US
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Telephone | 281-626-7986
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Fax | 281-688-1888
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | DR. JULIE A SWANSON
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Credential | PH.D.
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Telephone | 281-626-7986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 34785
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License Number State | TX
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