1932526365 NPI number — MR. KURT M. SNYDER LMFT

Table of content: MR. KURT M. SNYDER LMFT (NPI 1932526365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932526365 NPI number — MR. KURT M. SNYDER LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SNYDER
Provider First Name:
KURT
Provider Middle Name:
M.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
M

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:
1932526365
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11123 PARKVIEW PLAZA DR. STE 200
Provider Second Line Business Mailing Address:
ATTN: WIELAND & ASSOCIATES
Provider Business Mailing Address City Name:
FORT WAYNE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-672-6510
Provider Business Mailing Address Fax Number:
260-672-6501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11123 PARKVIEW PLAZA DR.
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-672-6510
Provider Business Practice Location Address Fax Number:
260-672-6501
Provider Enumeration Date:
03/24/2014

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: 106H00000X , with the licence number:  35-00181CA , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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