Healthcare Provider Details

I. General information

NPI: 1619002516
Provider Name (Legal Business Name): BRIAN SNIDER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7608 E 91ST ST STE 212
TULSA OK
74133-6014
US

IV. Provider business mailing address

7608 E. 91ST. ST. STE 212
TULSA OK
74133
US

V. Phone/Fax

Practice location:
  • Phone: 918-492-2480
  • Fax: 918-492-8930
Mailing address:
  • Phone: 918-492-2480
  • Fax: 918-492-8930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number913
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: