MEDICARE: STANLEY JAMES SWINGLE II LCSW

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	1041C0700X	Clinical Social Worker	S02401	TX
2	106H00000X	Marriage & Family Therapist	S02401	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	86288Q	OTHER	TX	BCBS ID WITH GROUP

General Provider Information

NPI Number	:	1578566642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANLEY JAMES SWINGLE II LCSW

Provider Business Mailing Address
First Line	:	901 WALLACE BLVD
Second Line	:	BLDG 501
City	:	AMARILLO
State	:	TX
Zip	:	79106-1705
Country	:	US
Telephone Number	:	806-349-5621
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 WALLACE BLVD
Second Line	:	BLDG 501
City	:	AMARILLO
State	:	TX
Zip	:	79106-1705
Country	:	US
Telephone Number	:	806-349-5621
Fax Number	:

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	09/11/2025

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