Provider Demographics
NPI:1033126891
Name:SNYDER, DANIEL L (PHD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:SNYDER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 CLAYSTONE ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5765
Mailing Address - Country:US
Mailing Address - Phone:616-949-7460
Mailing Address - Fax:616-949-3018
Practice Address - Street 1:3330 CLAYSTONE ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5765
Practice Address - Country:US
Practice Address - Phone:616-949-7460
Practice Address - Fax:616-949-3018
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009158103T00000X
MI1-01610103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11289266OtherCAQH
MI68OD146520OtherBLUE CROSS BLUE SHIELD
MIP106527OtherBLUE CARE NETWORK
0M32440Medicare ID - Type Unspecified
MI11289266OtherCAQH