1306338926 NPI number — VICKY A SNYDER LASAC, LPC

Table of content: VICKY A SNYDER LASAC, LPC (NPI 1306338926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306338926 NPI number — VICKY A SNYDER LASAC, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SNYDER
Provider First Name:
VICKY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LASAC, LPC
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:
1306338926
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8644 W PEORIA AVE, SUITE 6
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-507-7595
Provider Business Mailing Address Fax Number:
602-429-8154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8466 W PEORIA AVE STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-507-7595
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2018

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: 101YA0400X , with the licence number:  13323 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 17570 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 473197 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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