Provider Demographics
NPI:1184857120
Name:SWANN, LAURA JONES (MED, LCDC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JONES
Last Name:SWANN
Suffix:
Gender:F
Credentials:MED, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WEST DEAN KEETON
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712
Mailing Address - Country:US
Mailing Address - Phone:512-475-8352
Mailing Address - Fax:512-475-8459
Practice Address - Street 1:100 E DEAN KEETON ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1043
Practice Address - Country:US
Practice Address - Phone:521-475-8352
Practice Address - Fax:512-475-8459
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4752101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)