Provider Demographics
NPI:1588899470
Name:SWINEHEART, DAVID LEE (MA, LCSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:SWINEHEART
Suffix:
Gender:M
Credentials:MA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 TALL TIMBER TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4345
Mailing Address - Country:US
Mailing Address - Phone:260-459-1966
Mailing Address - Fax:
Practice Address - Street 1:215 E VAN BUREN ST
Practice Address - Street 2:SUITE 107
Practice Address - City:COLUMBIA CITY
Practice Address - State:IN
Practice Address - Zip Code:46725-2148
Practice Address - Country:US
Practice Address - Phone:260-750-4857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003123A1041C0700X
IN35000640A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist