Provider Demographics
NPI:1700120284
Name:SWALES, STEPHANIE (PHD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SWALES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3614 FAIRMOUNT ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4709
Mailing Address - Country:US
Mailing Address - Phone:469-426-4632
Mailing Address - Fax:
Practice Address - Street 1:3614 FAIRMOUNT ST
Practice Address - Street 2:SUITE 4
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4709
Practice Address - Country:US
Practice Address - Phone:469-426-4632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36416103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical