Healthcare Provider Details

I. General information

NPI: 1619714417
Provider Name (Legal Business Name): BROOKE SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 JEFFERSON ST
CLARKSVILLE TN
37040-3292
US

IV. Provider business mailing address

800 LEIGH ANN DR
CLARKSVILLE TN
37042-4282
US

V. Phone/Fax

Practice location:
  • Phone: 615-348-5806
  • Fax:
Mailing address:
  • Phone: 931-644-0862
  • 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: