Healthcare Provider Details

I. General information

NPI: 1023162682
Provider Name (Legal Business Name): MARK E. SNOW PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MARK E. SNOW PHD

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 12/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N. ALLUMBAUGH ST
BOISE ID
83704-9208
US

IV. Provider business mailing address

311 N. ALLUMBAUGH ST
BOISE ID
83704-9208
US

V. Phone/Fax

Practice location:
  • Phone: 208-375-6402
  • Fax: 208-323-1850
Mailing address:
  • Phone: 208-375-6402
  • Fax: 208-323-1850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-61
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: