Healthcare Provider Details

I. General information

NPI: 1285726513
Provider Name (Legal Business Name): GARY ALEXANDER SNAPPER LLP, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 S BURDICK ST
KALAMAZOO MI
49007-5221
US

IV. Provider business mailing address

610 S BURDICK ST
KALAMAZOO MI
49007-5221
US

V. Phone/Fax

Practice location:
  • Phone: 269-381-3700
  • Fax: 269-381-3810
Mailing address:
  • Phone: 269-381-3700
  • Fax: 269-381-3810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301012481
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401008761
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: