Provider Demographics
NPI:1144805623
Name:SWETNAM, AMY JEAN (MS, LPC, LCDC, CEAP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JEAN
Last Name:SWETNAM
Suffix:
Gender:F
Credentials:MS, LPC, LCDC, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 LINDNER AVE
Mailing Address - Street 2:
Mailing Address - City:COMFORT
Mailing Address - State:TX
Mailing Address - Zip Code:78013-2619
Mailing Address - Country:US
Mailing Address - Phone:817-690-3491
Mailing Address - Fax:
Practice Address - Street 1:503 LINDNER AVE
Practice Address - Street 2:
Practice Address - City:COMFORT
Practice Address - State:TX
Practice Address - Zip Code:78013-2619
Practice Address - Country:US
Practice Address - Phone:817-690-3491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX801101YA0400X
TX12759101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)