Provider Demographics
NPI:1598344590
Name:SWICK CLINICAL SERVICES INC
Entity Type:Organization
Organization Name:SWICK CLINICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SWICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:458-600-6101
Mailing Address - Street 1:PO BOX 7964
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-7964
Mailing Address - Country:US
Mailing Address - Phone:541-241-6123
Mailing Address - Fax:
Practice Address - Street 1:5 NW FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2905
Practice Address - Country:US
Practice Address - Phone:541-241-6123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORL8208OtherOBLSW LICENSURE
OR19-10-29OtherMHACBO CADC
OR1982943247Medicaid