Provider Demographics
NPI:1407016173
Name:SWOBODA, NATHAN E (LPC)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:E
Last Name:SWOBODA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 CENTERVIEW
Mailing Address - Street 2:SUITE 266
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1214
Mailing Address - Country:US
Mailing Address - Phone:210-355-8840
Mailing Address - Fax:
Practice Address - Street 1:4606 CENTERVIEW
Practice Address - Street 2:SUITE 266
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1214
Practice Address - Country:US
Practice Address - Phone:210-335-8840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60248101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193848202Medicaid