Basic Information
| Provider Information | |||||||||
| NPI: | 1003965526 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SWIFT | ||||||||
| FirstName: | GREGORY | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 823 EARLHAM STREET #1 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911011273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263946797 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1151 6TH STREET | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900171828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2136392562 | ||||||||
| FaxNumber: | 2133859246 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2007 | ||||||||
| LastUpdateDate: | 05/30/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 36825 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.