Active NPI
John Davenport Swan Jr., LMHC
- Mental Health Counselor
- Wilton Manors, FL
National Provider Identifier
1356868483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MH15302
- Practice address
- 2312 Wilton Dr
Wilton Manors, FL 33305-1249 - Phone
- (954) 764-5150
- NPI assigned
- Aug 29, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MH15302 | FL | Primary |
Addresses
Primary practice location
2312 Wilton Dr
Wilton Manors, FL 33305-1249
Mailing address
2312 Wilton Dr
Wilton Manors, FL 33305-1249
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MH15302 | FL | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shine Medical Providers PC | Single Specialty | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1503964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1503964800000",
"number": "1356868483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2312 WILTON DR",
"city": "WILTON MANORS",
"state": "FL",
"postal_code": "333051249"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2312 WILTON DR",
"city": "WILTON MANORS",
"state": "FL",
"postal_code": "333051249",
"telephone_number": "954-764-5150"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SWAN",
"first_name": "JOHN",
"middle_name": "DAVENPORT",
"name_suffix": "Jr.",
"credential": "LMHC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-08-29",
"last_updated": "2017-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "MH15302",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilton Manors, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.