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General NPI Number Information
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NPI Number | 1730699984
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Entity Type | Organization
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Legal Business Name | ADULT YOUTH @ SWANSON COUNSELING LLC
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 803 W 4TH ST STE D
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City | PUEBLO
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State | CO
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Zip | 81003-2392
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Country | US
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Telephone | 719-225-8639
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Fax |
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Provider Business Mailing Address
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Address Line | 803 W 4TH ST STE D
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City | PUEBLO
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State | CO
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Zip | 81003-2392
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY SWANSON
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Credential |
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Telephone | 719-641-4917
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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 | CSWOO923464
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ACB7020
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License Number State | CO
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