Provider Demographics
NPI:1770768236
Name:SWISTEK, RICHARD J (MS)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:J
Last Name:SWISTEK
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1101
Mailing Address - Street 2:
Mailing Address - City:COLLEGEDALE
Mailing Address - State:TN
Mailing Address - Zip Code:37315-1101
Mailing Address - Country:US
Mailing Address - Phone:423-432-7964
Mailing Address - Fax:423-702-5512
Practice Address - Street 1:1401 WILLIAMS ST
Practice Address - Street 2:SUITE 206
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37408-1101
Practice Address - Country:US
Practice Address - Phone:423-702-5508
Practice Address - Fax:423-702-5512
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000002126101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1503322Medicaid