1346488830 NPI number — LIANA G SNYDER MFT

Table of content: LIANA G SNYDER MFT (NPI 1346488830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346488830 NPI number — LIANA G SNYDER MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SNYDER
Provider First Name:
LIANA
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346488830
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11700 W CHARLESTON BLVD
Provider Second Line Business Mailing Address:
#170-40
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89135-1573
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-808-8538
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3595 S TOWN CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89135-3019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-808-8538
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MF01097 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: 1204 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1204 . This is a "LADC" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: MF01097 . This is a "MFT LICENSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 880503685 . This is a "TAX ID" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".