Provider Demographics
NPI:1407379571
Name:SWENSON, LAREISSA MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAREISSA
Middle Name:MARIE
Last Name:SWENSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:LAREISSA-MARIE
Other - Middle Name:
Other - Last Name:SWENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:502 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:MT
Mailing Address - Zip Code:59644-2008
Mailing Address - Country:US
Mailing Address - Phone:406-980-1741
Mailing Address - Fax:
Practice Address - Street 1:502 N PINE ST
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:MT
Practice Address - Zip Code:59644-2008
Practice Address - Country:US
Practice Address - Phone:406-980-1741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2020-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-246271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical