Healthcare Provider Details

I. General information

NPI: 1679342067
Provider Name (Legal Business Name): KEVIN R. SNYDER PLMHP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 W 48TH ST STE 4
KEARNEY NE
68845-1224
US

IV. Provider business mailing address

9373 S BASCOM DR
SHELTON NE
68876-9795
US

V. Phone/Fax

Practice location:
  • Phone: 308-216-0605
  • Fax:
Mailing address:
  • Phone: 308-216-0605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13732
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: