Provider Demographics
NPI:1871721365
Name:SWISHER, NATHAN KYLE (PSYD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:KYLE
Last Name:SWISHER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8217 W 20TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3033
Mailing Address - Country:US
Mailing Address - Phone:970-353-2000
Mailing Address - Fax:970-356-4827
Practice Address - Street 1:8217 W 20TH ST STE A
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634
Practice Address - Country:US
Practice Address - Phone:970-353-2000
Practice Address - Fax:970-356-4827
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003840103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical