Provider Demographics
NPI:1356513956
Name:SWANSON, SHANNON ANNA-MARIE (MA, LMFT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ANNA-MARIE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3255
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92654-3255
Mailing Address - Country:US
Mailing Address - Phone:949-572-4044
Mailing Address - Fax:
Practice Address - Street 1:22471 ASPAN ST STE 103
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1644
Practice Address - Country:US
Practice Address - Phone:949-458-2715
Practice Address - Fax:949-458-3583
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150309106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist