Provider Demographics
NPI:1023441557
Name:SWANSON, NILS ANDERS (LMHC)
Entity type:Individual
Prefix:MR
First Name:NILS
Middle Name:ANDERS
Last Name:SWANSON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 LAKE CENTER LOOP
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-2211
Mailing Address - Country:US
Mailing Address - Phone:352-383-2194
Mailing Address - Fax:352-383-2193
Practice Address - Street 1:531 S GROVE ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-4820
Practice Address - Country:US
Practice Address - Phone:352-720-3067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12296101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health