| Doctor Name: | MR. NILS ANDERS SWANSON |
| NPI Number: | 1023441557 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.S. |
| License Number: | IMH 9706 |
| Business Practice Address: | 3750 Lake Center Loop Mount Dora, FL - 327572211 |
| Business Phone Number: | 3523832194 |
| Business Fax Number: | 3523832193 |
| Mailing Address: | 3750 Lake Center Loop, MOUNT DORA |
| State: | FL |
| Postal Code: | 327572211 |
| Phone Number: | 3523832194 |
| Fax Number: | 3523832193 |
| NPI Enumeration Date: | 08/20/2013 |
| NPI Last Update Date: | 08/20/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | IMH 9706 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |