Healthcare Provider Details

I. General information

NPI: 1033126891
Provider Name (Legal Business Name): DANIEL L SNYDER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 CLAYSTONE ST SE
GRAND RAPIDS MI
49546-5765
US

IV. Provider business mailing address

3330 CLAYSTONE ST SE
GRAND RAPIDS MI
49546-5765
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-7460
  • Fax: 616-949-3018
Mailing address:
  • Phone: 616-949-7460
  • Fax: 616-949-3018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301009158
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number1-01610
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: