Provider Demographics
NPI:1194849422
Name:BARBARA SWAIN, PHD, PC
Entity Type:Organization
Organization Name:BARBARA SWAIN, PHD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:928-778-4745
Mailing Address - Street 1:143 N MCCORMICK ST STE 103
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-2725
Mailing Address - Country:US
Mailing Address - Phone:928-778-4745
Mailing Address - Fax:928-778-3464
Practice Address - Street 1:143 N MCCORMICK ST STE 103
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2725
Practice Address - Country:US
Practice Address - Phone:928-778-4745
Practice Address - Fax:928-778-3464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1508103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0600710OtherBLUE CROSS BLUE SHIELD AZ
AZAZ0600710OtherBLUE CROSS BLUE SHIELD AZ