Healthcare Provider Details

I. General information

NPI: 1922605054
Provider Name (Legal Business Name): MR. KENNETH EUGENE SNYDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 COHASSET RD STE 180
CHICO CA
95926-2460
US

IV. Provider business mailing address

3809 GRANDA VISTA DR
PARADISE CA
95969-5661
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-2810
  • Fax:
Mailing address:
  • Phone: 530-566-4380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: