Provider Demographics
NPI:1184211807
Name:SNELL, JUSTIN (L A C)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:SNELL
Suffix:
Gender:M
Credentials:L A C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8444 N 90TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4437
Mailing Address - Country:US
Mailing Address - Phone:602-248-8886
Mailing Address - Fax:602-248-8999
Practice Address - Street 1:8707 JACKRABBIT LN
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-8995
Practice Address - Country:US
Practice Address - Phone:406-404-7900
Practice Address - Fax:406-388-2474
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-46166101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)