Provider Demographics
NPI:1952059503
Name:SWANGO, BRIANNE S (MA, LMHCA, NCC)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:S
Last Name:SWANGO
Suffix:
Gender:F
Credentials:MA, LMHCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13677 ABERDEEN RD
Mailing Address - Street 2:
Mailing Address - City:DILLSBORO
Mailing Address - State:IN
Mailing Address - Zip Code:47018-5114
Mailing Address - Country:US
Mailing Address - Phone:812-584-0868
Mailing Address - Fax:
Practice Address - Street 1:13677 ABERDEEN RD
Practice Address - Street 2:
Practice Address - City:DILLSBORO
Practice Address - State:IN
Practice Address - Zip Code:47018-5114
Practice Address - Country:US
Practice Address - Phone:812-584-0868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88000958A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty