=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316510530
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE ROSE SNYDER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2021
-----------------------------------------------------
Last Update Date | 05/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 633 E 63RD ST STE 230
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64110-3331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-209-0120
-----------------------------------------------------
Fax | 316-932-1556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6112 N CLEVELAND AVE
-----------------------------------------------------
City | GLADSTONE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64119-1942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-209-0120
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 2019043835
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------