Provider Demographics
NPI:1932580156
Name:SWICK., SIERRA COLLEEN (LCPC)
Entity type:Individual
Prefix:MRS
First Name:SIERRA
Middle Name:COLLEEN
Last Name:SWICK.
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7122 W MANCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:RATHDRUM
Mailing Address - State:ID
Mailing Address - Zip Code:83858-8225
Mailing Address - Country:US
Mailing Address - Phone:208-403-2402
Mailing Address - Fax:
Practice Address - Street 1:13403 N GOVERNMENT WAY STE 319
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8914
Practice Address - Country:US
Practice Address - Phone:208-403-2402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-6987101YM0800X
IDLCPC6987101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor