Healthcare Provider Details

I. General information

NPI: 1972985562
Provider Name (Legal Business Name): MARIAH SNAPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIAH NEVEAU LCSW

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 10/10/2020
Certification Date: 10/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 HILLWOOD PKWY STE 140
FORT WORTH TX
76177-1532
US

IV. Provider business mailing address

5060 CASSIDY LN
FORT WORTH TX
76244-9171
US

V. Phone/Fax

Practice location:
  • Phone: 682-738-6409
  • Fax:
Mailing address:
  • Phone: 606-776-8047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number60751
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: