Healthcare Provider Details

I. General information

NPI: 1790027720
Provider Name (Legal Business Name): MICHELLE M SNYDER MA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2013
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 SADDLEBROOK PASS
CHANHASSEN MN
55317-9040
US

IV. Provider business mailing address

940 SADDLEBROOK PASS
CHANHASSEN MN
55317-9040
US

V. Phone/Fax

Practice location:
  • Phone: 952-855-3897
  • Fax:
Mailing address:
  • Phone: 952-855-3897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1173
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1173
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: