Healthcare Provider Details

I. General information

NPI: 1245082379
Provider Name (Legal Business Name): ANDREW NORMAN SNELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WILFORD HALL LOOP BLDG 4554 59 MDW/GME
JBSA LACKLAND TX
78236-5638
US

IV. Provider business mailing address

1100 WILFORD HALL LOOP BLDG 4554 59 MDW/GME
JBSA LACKLAND TX
78236-5638
US

V. Phone/Fax

Practice location:
  • Phone: 210-292-5972
  • Fax:
Mailing address:
  • Phone: 210-292-5972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number40877
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: