Provider Demographics
NPI:1679288328
Name:SWEARENGIN, MICHAEL CODY (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CODY
Last Name:SWEARENGIN
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:MR
Other - First Name:CODY
Other - Middle Name:
Other - Last Name:SWEARENGIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:412 HIGHTOWER AVE
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-9464
Mailing Address - Country:US
Mailing Address - Phone:417-840-0426
Mailing Address - Fax:
Practice Address - Street 1:704 N 22ND ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-8662
Practice Address - Country:US
Practice Address - Phone:417-413-4544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018044932101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional