Provider Demographics
NPI:1316099807
Name:SWIETZER, THOMAS L (LCPC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:L
Last Name:SWIETZER
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MCDIVITT DR
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-2162
Mailing Address - Country:US
Mailing Address - Phone:815-485-1542
Mailing Address - Fax:
Practice Address - Street 1:600 MCDIVITT DR
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-2162
Practice Address - Country:US
Practice Address - Phone:815-485-1542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical