Provider Demographics
NPI:1366228744
Name:SWANIGAN, LATRINA RENEE
Entity type:Individual
Prefix:
First Name:LATRINA
Middle Name:RENEE
Last Name:SWANIGAN
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 1:21111 BRUNSON FALLS DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1637
Mailing Address - Country:US
Mailing Address - Phone:281-222-6005
Mailing Address - Fax:
Practice Address - Street 1:1000 AUSTIN ST STE D
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-5275
Practice Address - Country:US
Practice Address - Phone:281-222-6005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91277101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty