Provider Demographics
NPI:1427389972
Name:CHENOWETH-SWIFT, CHARLA A (LCSW)
Entity Type:Individual
Prefix:
First Name:CHARLA
Middle Name:A
Last Name:CHENOWETH-SWIFT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHARLA
Other - Middle Name:A
Other - Last Name:CHENOWETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 940
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-0940
Mailing Address - Country:US
Mailing Address - Phone:719-680-4047
Mailing Address - Fax:
Practice Address - Street 1:916 ARIZONA AVE STE A
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2118
Practice Address - Country:US
Practice Address - Phone:719-680-4047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 41571041C0700X
COCSW.09924146104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200634150BMedicaid