Provider Demographics
NPI:1730764986
Name:KEITH WALLACE SWAIN PSYD LPC
Entity type:Organization
Organization Name:KEITH WALLACE SWAIN PSYD LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:WALLACE
Authorized Official - Last Name:SWAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:303-547-7397
Mailing Address - Street 1:790 N GILPIN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-3634
Mailing Address - Country:US
Mailing Address - Phone:303-547-7397
Mailing Address - Fax:
Practice Address - Street 1:790 N GILPIN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3634
Practice Address - Country:US
Practice Address - Phone:303-547-7397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service