Provider Demographics
NPI:1699794362
Name:SWIFT, TIMOTHY L (MA)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:L
Last Name:SWIFT
Suffix:
Gender:M
Credentials:MA
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 36552
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85067-6552
Mailing Address - Country:US
Mailing Address - Phone:480-703-7490
Mailing Address - Fax:
Practice Address - Street 1:202 E MCDOWELL RD
Practice Address - Street 2:SUITE 251
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-4588
Practice Address - Country:US
Practice Address - Phone:480-703-7490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10328101YA0400X
AZLPC-10554101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLISAC-10328OtherSUBSTANCE ABUSE COUN
AZLPC-10554OtherPROFESSIONAL COUNSELOR