Provider Demographics
NPI:1700406584
Name:SWAIN, JASON DAVID (TLMHC, PLMHP)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DAVID
Last Name:SWAIN
Suffix:
Gender:M
Credentials:TLMHC, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9224 RAVEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68152-1711
Mailing Address - Country:US
Mailing Address - Phone:402-321-2647
Mailing Address - Fax:
Practice Address - Street 1:1000 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566-1454
Practice Address - Country:US
Practice Address - Phone:712-581-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12149101YM0800X
IA100428101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health