Healthcare Provider Details

I. General information

NPI: 1760149694
Provider Name (Legal Business Name): THERESA SNYDER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2021
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 WASHINGTON BLVD
WILLIAMSPORT PA
17701-5426
US

IV. Provider business mailing address

690 DUNKLEBERGER RD
WILLIAMSPORT PA
17701-9266
US

V. Phone/Fax

Practice location:
  • Phone: 570-322-5051
  • Fax:
Mailing address:
  • Phone: 570-220-1856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC013898
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: