Healthcare Provider Details

I. General information

NPI: 1306178751
Provider Name (Legal Business Name): MARA E SNIDER MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARA ELIZABETH HERRIOTT MA

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 4TH ST
CRESCENT CITY CA
95531-4001
US

IV. Provider business mailing address

1515 ASHFORD RD
CRESCENT CITY CA
95531-9439
US

V. Phone/Fax

Practice location:
  • Phone: 707-954-0383
  • Fax:
Mailing address:
  • Phone: 707-954-0383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number105397
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number105397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: