Provider Demographics
NPI:1295791473
Name:SWANSON, JULIE DAWN (MA LPCC)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:DAWN
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MA LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1001 W BROADWAY STE D
Mailing Address - Street 2:2344 E16TH SST
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5638
Mailing Address - Country:US
Mailing Address - Phone:505-566-0353
Mailing Address - Fax:505-325-9113
Practice Address - Street 1:1001 W BROADWAY STE D
Practice Address - Street 2:2700 F1 FARMINGTON AVE.
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5638
Practice Address - Country:US
Practice Address - Phone:505-566-0353
Practice Address - Fax:505-326-7879
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM0154101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health