Provider Demographics
NPI:1508095712
Name:SWIM, ROSE ELLEN (MFT-T)
Entity Type:Individual
Prefix:MISS
First Name:ROSE
Middle Name:ELLEN
Last Name:SWIM
Suffix:
Gender:F
Credentials:MFT-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12712 HEACOCK ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-3037
Mailing Address - Country:US
Mailing Address - Phone:951-571-3540
Mailing Address - Fax:866-896-6067
Practice Address - Street 1:12712 HEACOCK ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3037
Practice Address - Country:US
Practice Address - Phone:951-571-3540
Practice Address - Fax:866-896-6067
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist