Provider Demographics
NPI:1134407679
Name:SWAN-SMITH, PATRICIA ANN (LCPC, LPC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:SWAN-SMITH
Suffix:
Gender:F
Credentials:LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1362
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-1362
Mailing Address - Country:US
Mailing Address - Phone:406-470-2698
Mailing Address - Fax:307-637-2899
Practice Address - Street 1:2622 PIONEER AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3024
Practice Address - Country:US
Practice Address - Phone:406-470-2698
Practice Address - Fax:307-637-2899
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2428101YM0800X
TNLPC0000002548101YP2500X
AK575101YP2500X
GALPC005909101YP2500X
WYLPC-1608101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000749930OtherBLUE CROSS-SHIELD OF MONTANA