Healthcare Provider Details

I. General information

NPI: 1750423984
Provider Name (Legal Business Name): HERNDON SNIDER & ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 E 32ND ST SUITE 221
JOPLIN MO
64804-4313
US

IV. Provider business mailing address

2650 E 32ND ST SUITE 221
JOPLIN MO
64804-4313
US

V. Phone/Fax

Practice location:
  • Phone: 417-623-1381
  • Fax: 417-623-0457
Mailing address:
  • Phone: 417-623-1381
  • Fax: 417-623-0457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number01592
License Number StateMO

VIII. Authorized Official

Name: MRS. JAN SNIDER KENT
Title or Position: CEO
Credential: PH.D.
Phone: 417-623-1381