Healthcare Provider Details

I. General information

NPI: 1467805556
Provider Name (Legal Business Name): MRS. MARY ADELE SNIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 C ST NW
ARDMORE OK
73401-5831
US

IV. Provider business mailing address

603 C ST NW
ARDMORE OK
73401-5831
US

V. Phone/Fax

Practice location:
  • Phone: 580-222-7907
  • Fax:
Mailing address:
  • Phone: 580-222-7907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: