MEDICARE: DR. NICOLE SUZANNE SNYDER LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0017136	CO

General Provider Information

NPI Number	:	1386397214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE SUZANNE SNYDER LPC

Provider Business Mailing Address
First Line	:	260 S YARROW ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-1528
Country	:	US
Telephone Number	:	630-747-5219
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 S YARROW ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-1528
Country	:	US
Telephone Number	:	303-233-3430
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2022
Last Update Date	:	01/31/2022

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