Provider Demographics
NPI:1104064740
Name:SWIFTFOOT, MARIA (LLP, LLPC, CMMT)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:SWIFTFOOT
Suffix:
Gender:F
Credentials:LLP, LLPC, CMMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2174
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49003-2174
Mailing Address - Country:US
Mailing Address - Phone:269-312-1446
Mailing Address - Fax:
Practice Address - Street 1:4341 S WESTNEDGE AVE STE 1106
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3283
Practice Address - Country:US
Practice Address - Phone:269-312-1446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007071101YP2500X
MI6301010873103TC1900X
MI6361000784103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling