=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922165786
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW THOMAS SWAN LCPC, LCPAT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2007
-----------------------------------------------------
Last Update Date | 02/24/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 260 GATEWAY DR SUITE 3-4B
-----------------------------------------------------
City | BEL AIR
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21014-4268
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-838-9558
-----------------------------------------------------
Fax | 410-838-9599
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 260 GATEWAY DR SUITE 3-4B
-----------------------------------------------------
City | BEL AIR
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21014-4268
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-838-9558
-----------------------------------------------------
Fax | 410-838-9599
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | ATC009
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LC2252
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------