Provider Demographics
NPI:1942659743
Name:TWO SWANS COUNSELING SERVICE, P.L.L.C.
Entity Type:Organization
Organization Name:TWO SWANS COUNSELING SERVICE, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:580-699-2011
Mailing Address - Street 1:711 SW D AVE SUITE 203
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-4561
Mailing Address - Country:US
Mailing Address - Phone:580-699-2011
Mailing Address - Fax:580-699-2012
Practice Address - Street 1:711 SW D AVE STE 203
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-4561
Practice Address - Country:US
Practice Address - Phone:580-699-2011
Practice Address - Fax:580-699-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2468101YP2500X
LA914106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty