Provider Demographics
NPI:1801620364
Name:SWIMMER, ADDIE BETH
Entity type:Individual
Prefix:MRS
First Name:ADDIE
Middle Name:BETH
Last Name:SWIMMER
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 1:105 N HASWELL DR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77803-4848
Mailing Address - Country:US
Mailing Address - Phone:806-220-6910
Mailing Address - Fax:
Practice Address - Street 1:543 WILLIAM D FITCH PKWY
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6139
Practice Address - Country:US
Practice Address - Phone:979-431-0697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor