Provider Demographics
NPI:1588796361
Name:SWAN, TERRY L (MS, RC)
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:L
Last Name:SWAN
Suffix:
Gender:F
Credentials:MS, RC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 S 4TH AVE
Mailing Address - Street 2:CENTRAL WA COMPREHENSIVE MENTAL HEALTH
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3546
Mailing Address - Country:US
Mailing Address - Phone:509-575-2215
Mailing Address - Fax:509-575-4811
Practice Address - Street 1:402 S 4TH AVE
Practice Address - Street 2:CENTRAL WA COMPREHENSIVE MENTAL HEALTH
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3546
Practice Address - Country:US
Practice Address - Phone:509-575-2215
Practice Address - Fax:509-575-4811
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00055711101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional