=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952059503
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIANNE S SWANGO MA, LMHCA, NCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2022
-----------------------------------------------------
Last Update Date | 03/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13677 ABERDEEN RD
-----------------------------------------------------
City | DILLSBORO
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47018-5114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-584-0868
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13677 ABERDEEN RD
-----------------------------------------------------
City | DILLSBORO
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47018-5114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-584-0868
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 88000958A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------