Provider Demographics
NPI:1679930671
Name:SWAYNE, ERIK (LMSW)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:
Last Name:SWAYNE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 N BEACH ST
Mailing Address - Street 2:1226
Mailing Address - City:HALTOM CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76137-2812
Mailing Address - Country:US
Mailing Address - Phone:682-429-7066
Mailing Address - Fax:
Practice Address - Street 1:2307 GRAVEL DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76118-6951
Practice Address - Country:US
Practice Address - Phone:682-429-7066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX377651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical