MEDICARE: MRS. JULIE DAWN SWANSON MA LPCC

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	0154	NM

General Provider Information

NPI Number	:	1295791473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE DAWN SWANSON MA LPCC

Provider Business Mailing Address
First Line	:	1001 W BROADWAY STE D
Second Line	:	2344 E16TH SST
City	:	FARMINGTON
State	:	NM
Zip	:	87401-5638
Country	:	US
Telephone Number	:	505-566-0353
Fax Number	:	505-325-9113

Provider Business Practice Location Address
First Line	:	1001 W BROADWAY STE D
Second Line	:	2700 F1 FARMINGTON AVE.
City	:	FARMINGTON
State	:	NM
Zip	:	87401-5638
Country	:	US
Telephone Number	:	505-566-0353
Fax Number	:	505-326-7879

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	04/29/2010

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