Healthcare Provider Details

I. General information

NPI: 1225367261
Provider Name (Legal Business Name): KIM MARIE SNYDER MS, LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2009
Last Update Date: 12/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37677 PROFESSIONAL CENTER DR
LIVONIA MI
48154-1192
US

IV. Provider business mailing address

37360 BRISTOL ST
LIVONIA MI
48154-1764
US

V. Phone/Fax

Practice location:
  • Phone: 734-591-6277
  • Fax:
Mailing address:
  • Phone: 734-765-6563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401011060
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: