Provider Demographics
NPI:1639234081
Name:SWANSON, KIM (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:5005 LAMART DRIVE
Mailing Address - Street 2:SUITE 100B4
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507
Mailing Address - Country:US
Mailing Address - Phone:951-534-6599
Mailing Address - Fax:
Practice Address - Street 1:5005 LAMART DRIVE
Practice Address - Street 2:SUITE 100B4
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507
Practice Address - Country:US
Practice Address - Phone:951-534-6599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 37862106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist