Provider Demographics
NPI:1699104455
Name:SWANSON, JULIE A (PHD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:SWANSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 NASA PKWY # 1106
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3039
Mailing Address - Country:US
Mailing Address - Phone:281-626-7986
Mailing Address - Fax:281-688-1888
Practice Address - Street 1:19200 SPACE CENTER BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3736
Practice Address - Country:US
Practice Address - Phone:281-626-7986
Practice Address - Fax:281-688-1888
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34785103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX400531ZNASMedicare PIN