Provider Demographics
NPI:1487711750
Name:SWANSON, MARY RUTH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:RUTH
Last Name:SWANSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2504 GOOD SHEPHERD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801
Mailing Address - Country:US
Mailing Address - Phone:325-642-7882
Mailing Address - Fax:512-233-2310
Practice Address - Street 1:114 CENTER AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-3135
Practice Address - Country:US
Practice Address - Phone:325-642-7882
Practice Address - Fax:512-233-2310
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX304651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX30465OtherTX STATE BOARD OF SW EXAM
TX000000022POtherBLUE CROSS BLUE SHIELD
TX0713729-02Medicaid