Healthcare Provider Details

I. General information

NPI: 1326855701
Provider Name (Legal Business Name): JEFFREY DUANE SNYDER LPC LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8905 AIRPORT RD BLDG 111
BERKELEY MO
63134-1934
US

IV. Provider business mailing address

60 MADISON AVE FL 2
NEW YORK NY
10010-1600
US

V. Phone/Fax

Practice location:
  • Phone: 866-719-5788
  • Fax:
Mailing address:
  • Phone: 866-719-5788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002948
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001457
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: