Healthcare Provider Details

I. General information

NPI: 1700213550
Provider Name (Legal Business Name): DAVID A SNYDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2013
Last Update Date: 10/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 RADIO PARK DR
RICHMOND KY
40475-2346
US

IV. Provider business mailing address

900 BEASLEY ST
LEXINGTON KY
40509-4266
US

V. Phone/Fax

Practice location:
  • Phone: 859-582-3776
  • Fax: 859-254-2075
Mailing address:
  • Phone: 859-254-1035
  • Fax: 859-254-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1577
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: