Provider Demographics
NPI:1063534261
Name:SWANSTON, SELWYN WINSTON (LPC)
Entity type:Individual
Prefix:
First Name:SELWYN
Middle Name:WINSTON
Last Name:SWANSTON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3154 GOLFSIDE DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-3770
Mailing Address - Country:US
Mailing Address - Phone:734-635-6553
Mailing Address - Fax:
Practice Address - Street 1:3154 GOLFSIDE DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-3770
Practice Address - Country:US
Practice Address - Phone:734-635-6553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401000849101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional