Provider Demographics
NPI:1841497435
Name:SWIFT STEPS
Entity type:Organization
Organization Name:SWIFT STEPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:SWIFT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:417-496-9650
Mailing Address - Street 1:1444 EAST BRADFORD PKWY
Mailing Address - Street 2:C 204
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-6529
Mailing Address - Country:US
Mailing Address - Phone:417-496-9650
Mailing Address - Fax:
Practice Address - Street 1:1444 E BRADFORD PKWY
Practice Address - Street 2:C 204
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6563
Practice Address - Country:US
Practice Address - Phone:417-496-9650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999140468103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507592004Medicaid