Provider Demographics
NPI:1689963506
Name:JAIN, SWARN SHUBBI (LMHC)
Entity Type:Individual
Prefix:
First Name:SWARN
Middle Name:SHUBBI
Last Name:JAIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 CONSTITUTION DRIVE
Mailing Address - Street 2:SUMMIT COUNSELING
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-1517
Mailing Address - Country:US
Mailing Address - Phone:260-969-3445
Mailing Address - Fax:
Practice Address - Street 1:6201 CONSTITUTION DRIVE
Practice Address - Street 2:SUMMIT COUNSELING
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1517
Practice Address - Country:US
Practice Address - Phone:260-969-3445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002224A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health