Provider Demographics
NPI:1619576386
Name:SWENSON, TAWNYA (LAC)
Entity Type:Individual
Prefix:
First Name:TAWNYA
Middle Name:
Last Name:SWENSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3970 W 24TH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-9255
Mailing Address - Country:US
Mailing Address - Phone:928-373-8041
Mailing Address - Fax:928-259-2501
Practice Address - Street 1:3970 W 24TH ST STE 206
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-9255
Practice Address - Country:US
Practice Address - Phone:928-373-8041
Practice Address - Fax:928-259-2501
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-17468101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLAC-17468OtherAZ BOARD OF BEHAVIORAL HEALTH EXAMINERS