Provider Demographics
NPI:1972327492
Name:SWAN, AMANDA R (LPC, QMHP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:SWAN
Suffix:
Gender:
Credentials:LPC, QMHP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:R
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:522 7TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-2756
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:522 7TH ST STE 202
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2756
Practice Address - Country:US
Practice Address - Phone:850-819-6457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-20930101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health