MEDICARE: NILS SWANSON LMHC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1033783204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NILS SWANSON LMHC LLC

Provider Business Mailing Address
First Line	:	851 N DONNELLY ST
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-4835
Country	:	US
Telephone Number	:	352-760-3067
Fax Number	:

Provider Business Practice Location Address
First Line	:	531 S GROVE ST
Second Line	:
City	:	EUSTIS
State	:	FL
Zip	:	32726-4820
Country	:	US
Telephone Number	:	352-720-3067
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NILS SWANSON
Credential	:
Telephone Number	:	352-720-3067

Provider Enumeration Date	:	05/13/2021
Last Update Date	:	01/12/2024

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