Provider Demographics
NPI:1083276745
Name:SNOW, ALEXANDER TIMOTHY
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:TIMOTHY
Last Name:SNOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 4TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-4000
Mailing Address - Country:US
Mailing Address - Phone:530-406-7993
Mailing Address - Fax:
Practice Address - Street 1:414 4TH ST STE D
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-4000
Practice Address - Country:US
Practice Address - Phone:530-406-7993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT132121106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist