Provider Demographics
NPI:1235763111
Name:SWANN CLINIC FOR BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:SWANN CLINIC FOR BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDY SWANN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:404-819-8900
Mailing Address - Street 1:1001 GRAND AVE
Mailing Address - Street 2:SUITE 005
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-3642
Mailing Address - Country:US
Mailing Address - Phone:970-924-0484
Mailing Address - Fax:970-549-2874
Practice Address - Street 1:1001 GRAND AVE
Practice Address - Street 2:SUITE 005
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3642
Practice Address - Country:US
Practice Address - Phone:404-819-8900
Practice Address - Fax:970-549-2874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-28
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1609225440Medicaid