Healthcare Provider Details

I. General information

NPI: 1265958771
Provider Name (Legal Business Name): CHAD SNYDER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 08/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7810 E. MACKENZIE DRIVE
SCOTTSDALE AZ
85251-8525
US

IV. Provider business mailing address

7810 E. MACKENZIE DRIVE
SCOTTSDALE AZ
85251
US

V. Phone/Fax

Practice location:
  • Phone: 412-606-6223
  • Fax: 412-606-6223
Mailing address:
  • Phone: 412-606-6223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-13681
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: