Provider Demographics
NPI:1740895754
Name:MIRANDA IGREJA SWAN, ANA ROSA
Entity type:Individual
Prefix:
First Name:ANA ROSA
Middle Name:
Last Name:MIRANDA IGREJA SWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 KEARNY BROOK PL
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-4034
Mailing Address - Country:US
Mailing Address - Phone:832-433-5014
Mailing Address - Fax:
Practice Address - Street 1:4540 CYPRESS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4602
Practice Address - Country:US
Practice Address - Phone:281-781-8703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12258815103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst