Provider Demographics
NPI:1962444901
Name:SWANBON, THOMAS (PHD, MP)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:SWANBON
Suffix:
Gender:M
Credentials:PHD, MP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1799 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-5345
Mailing Address - Country:US
Mailing Address - Phone:985-674-7758
Mailing Address - Fax:985-674-7758
Practice Address - Street 1:1799 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-5345
Practice Address - Country:US
Practice Address - Phone:985-674-7758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH952103TC0700X
LA1022103TC0700X
LA1022MP103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
Provider Identifiers
StateIdentifier IDID TypeIssuer
RE6087Medicare ID - Type Unspecified