Healthcare Provider Details

I. General information

NPI: 1700050341
Provider Name (Legal Business Name): SKY SNOGREN MA, LPC. LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 CANDY KITCHEN RD
RAMAH NM
87321-2851
US

IV. Provider business mailing address

488 CANDY KITCHEN RD HC61 BOX 4031
RAMAH NM
87321-2851
US

V. Phone/Fax

Practice location:
  • Phone: 541-301-5669
  • Fax:
Mailing address:
  • Phone: 541-301-5669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5315
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC4136
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2023-0496
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: