Provider Demographics
NPI:1538603642
Name:LISA SWAPP LLC
Entity type:Organization
Organization Name:LISA SWAPP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAPP
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:385-630-0336
Mailing Address - Street 1:P.O. BOX 782
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065
Mailing Address - Country:US
Mailing Address - Phone:385-630-0336
Mailing Address - Fax:
Practice Address - Street 1:9730 S 700 E
Practice Address - Street 2:SUITE 111
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3511
Practice Address - Country:US
Practice Address - Phone:385-630-0336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4976890-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty