Provider Demographics
NPI:1831180843
Name:SWANSON, PAMELA JOY (MED, LPC)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JOY
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 FARALLON DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5022
Mailing Address - Country:US
Mailing Address - Phone:928-453-5626
Mailing Address - Fax:928-453-8111
Practice Address - Street 1:351 FARALLON DR
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5022
Practice Address - Country:US
Practice Address - Phone:928-453-5626
Practice Address - Fax:928-453-8111
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-2152101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health