Provider Demographics
NPI:1548537152
Name:SWANBOROUGH, ALLAN NOEL (PHD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:NOEL
Last Name:SWANBOROUGH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 COMMERCIAL ST SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3462
Mailing Address - Country:US
Mailing Address - Phone:503-588-5767
Mailing Address - Fax:503-472-1722
Practice Address - Street 1:780 COMMERCIAL ST SE
Practice Address - Street 2:SUITE 100
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3462
Practice Address - Country:US
Practice Address - Phone:503-588-5767
Practice Address - Fax:503-472-1722
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR810126101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR810126OtherTSPC