Basic Information
| Provider Information | |||||||||
| NPI: | 1821767583 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SWANSON | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | FARRELL | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ASW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 S C ST | ||||||||
| Address2: | |||||||||
| City: | OXNARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930334560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053859420 | ||||||||
| FaxNumber: | 8053859401 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 S C ST | ||||||||
| Address2: | |||||||||
| City: | OXNARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930334560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053859420 | ||||||||
| FaxNumber: | 8053859401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2021 | ||||||||
| LastUpdateDate: | 06/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 94860 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.