MEDICARE: MEGAN JUNE SWENSON MA, LPC, LAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACD.0000319	CO
2	101YM0800X	Mental Health Counselor	LPC.0011989	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LPC.0011989	OTHER	CO	LICENSED PROFESSIONAL COUNSELOR

General Provider Information

NPI Number	:	1477890226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN JUNE SWENSON MA, LPC, LAC

Provider Business Mailing Address
First Line	:	5324 197TH AVE NE
Second Line	:
City	:	WYOMING
State	:	MN
Zip	:	55092-8511
Country	:	US
Telephone Number	:	720-505-0238
Fax Number	:

Provider Business Practice Location Address
First Line	:	7535 E HAMPDEN AVE # 407
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-4838
Country	:	US
Telephone Number	:	303-578-2702
Fax Number	:

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

Provider Enumeration Date	:	01/14/2013
Last Update Date	:	07/26/2023

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