Healthcare Provider Details

I. General information

NPI: 1255881702
Provider Name (Legal Business Name): JASON SNYDER LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2016
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 OVERLAND AVE STE 205
LOS ANGELES CA
90064-4243
US

IV. Provider business mailing address

2999 OVERLAND AVE STE 205
LOS ANGELES CA
90064-4243
US

V. Phone/Fax

Practice location:
  • Phone: 310-229-5229
  • Fax:
Mailing address:
  • Phone: 310-229-5229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT 95739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: