Provider Demographics
NPI:1629504626
Name:SWAINSTON, JOSHUA (MED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:SWAINSTON
Suffix:
Gender:M
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20457 STOCKBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-5533
Mailing Address - Country:US
Mailing Address - Phone:702-335-6102
Mailing Address - Fax:
Practice Address - Street 1:1404 W IDAHO ST STE 101
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5210
Practice Address - Country:US
Practice Address - Phone:208-968-7470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-17-33627106S00000X
NV1-19-38313103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician