Provider Demographics
NPI:1053306258
Name:SWANSON, MARK FRANKLIN (MC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:FRANKLIN
Last Name:SWANSON
Suffix:
Gender:M
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 E EQUESTRIAN TRL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-3009
Mailing Address - Country:US
Mailing Address - Phone:480-893-8614
Mailing Address - Fax:
Practice Address - Street 1:3231 S COUNTRY CLUB WAY
Practice Address - Street 2:SUITE 111
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-4053
Practice Address - Country:US
Practice Address - Phone:480-491-0835
Practice Address - Fax:480-491-5720
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 0994101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional