Provider Demographics
NPI:1518701853
Name:SWAN CITY PSYCHOLOGY P.A.
Entity type:Organization
Organization Name:SWAN CITY PSYCHOLOGY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MULLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:863-640-9080
Mailing Address - Street 1:2840 SEYMORE ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-3761
Mailing Address - Country:US
Mailing Address - Phone:863-640-9080
Mailing Address - Fax:
Practice Address - Street 1:1815 CRYSTAL LAKE DR # 1409
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5979
Practice Address - Country:US
Practice Address - Phone:863-640-9080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty