Provider Demographics
NPI:1457903999
Name:CHARLA SWIFT, LLC
Entity Type:Organization
Organization Name:CHARLA SWIFT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENOWETH-SWIFT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-680-4047
Mailing Address - Street 1:PO BOX 940
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-0940
Mailing Address - Country:US
Mailing Address - Phone:719-680-4047
Mailing Address - Fax:
Practice Address - Street 1:916 ARIZONA AVE STE A
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2118
Practice Address - Country:US
Practice Address - Phone:719-680-4047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty