Individual
CASEY SWANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1400 EMELINE AVE, SANTA CRUZ, CA 95060-1976
(831) 454-4170
Mailing address
1400 EMELINE AVE, SANTA CRUZ, CA 95060-1976
(831) 454-4170
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ91892Z
SANTA CRUZ COUNTY MEDICARE GROUP PTAN#
CA
01
—
ZZZ92069Z
SANTA CRUZ COUNTY MEDICARE GROUP PTAN#
CA
Enumeration date
08/23/2011
Last updated
08/23/2011
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