Provider Demographics
NPI:1750560835
Name:SWAYZE, AUDREY (LPC)
Entity type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:
Last Name:SWAYZE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 E 4000 N
Mailing Address - Street 2:
Mailing Address - City:FILER
Mailing Address - State:ID
Mailing Address - Zip Code:83328-5207
Mailing Address - Country:US
Mailing Address - Phone:208-326-7228
Mailing Address - Fax:
Practice Address - Street 1:220 4TH AVE E
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6312
Practice Address - Country:US
Practice Address - Phone:208-736-0695
Practice Address - Fax:208-735-2482
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-3627101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health