Healthcare Provider Details

I. General information

NPI: 1316510530
Provider Name (Legal Business Name): NICOLE ROSE SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2021
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 E 63RD ST STE 230
KANSAS CITY MO
64110-3331
US

IV. Provider business mailing address

6112 N CLEVELAND AVE
GLADSTONE MO
64119-1942
US

V. Phone/Fax

Practice location:
  • Phone: 316-209-0120
  • Fax: 316-932-1556
Mailing address:
  • Phone: 316-209-0120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2019043835
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: