Provider Demographics
NPI:1467844712
Name:JA SWANSON LICENSED CLINICAL PSYCHOLOGIST, PLLC
Entity type:Organization
Organization Name:JA SWANSON LICENSED CLINICAL PSYCHOLOGIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:281-626-7986
Mailing Address - Street 1:957 NASA PKWY # 1106
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3039
Mailing Address - Country:US
Mailing Address - Phone:281-626-7986
Mailing Address - Fax:281-688-1888
Practice Address - Street 1:19200 SPACE CENTER BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3736
Practice Address - Country:US
Practice Address - Phone:281-626-7986
Practice Address - Fax:281-688-1888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34785103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX400523Medicare PIN