Healthcare Provider Details

I. General information

NPI: 1548474117
Provider Name (Legal Business Name): MR. DENT ELWOOD SNIDER JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 WATER ST. #6
SANTA CRUZ CA
95060
US

IV. Provider business mailing address

290 PIONEER ST
SANTA CRUZ CA
95060-2133
US

V. Phone/Fax

Practice location:
  • Phone: 831-471-3900
  • Fax: 831-421-0480
Mailing address:
  • Phone: 831-459-0444
  • Fax: 831-459-0665

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: