Provider Demographics
NPI:1518112648
Name:SWANSON, SHIRLEY JEAN (MA LMHC)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:JEAN
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17023 DIKE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-9590
Mailing Address - Country:US
Mailing Address - Phone:360-333-1667
Mailing Address - Fax:
Practice Address - Street 1:321 W WASHINGTON ST
Practice Address - Street 2:SUITE #330
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5920
Practice Address - Country:US
Practice Address - Phone:360-333-1667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005150101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health