Provider Demographics
NPI:1477889715
Name:SWEARINGEN, JOSHUA JOHN (MBS)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:JOHN
Last Name:SWEARINGEN
Suffix:
Gender:M
Credentials:MBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-5008
Mailing Address - Country:US
Mailing Address - Phone:580-920-2069
Mailing Address - Fax:580-920-1010
Practice Address - Street 1:142 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-5008
Practice Address - Country:US
Practice Address - Phone:580-920-2069
Practice Address - Fax:580-920-1010
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4149101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health