Provider Demographics
NPI:1720357478
Name:SWENSON, THOMAS (MS,LCPC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:SWENSON
Suffix:
Gender:M
Credentials:MS,LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 ROUTE 83
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047
Mailing Address - Country:US
Mailing Address - Phone:847-821-1431
Mailing Address - Fax:847-821-1431
Practice Address - Street 1:4160 ROUTE 83
Practice Address - Street 2:SUITE 210
Practice Address - City:LONG GROVE
Practice Address - State:WI
Practice Address - Zip Code:60047
Practice Address - Country:US
Practice Address - Phone:847-821-1431
Practice Address - Fax:847-821-1431
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180000455101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health