Provider Demographics
NPI:1225367261
Name:SNYDER, KIM MARIE (MS, LLPC)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:MARIE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:MS, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37360 BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1764
Mailing Address - Country:US
Mailing Address - Phone:734-765-6563
Mailing Address - Fax:
Practice Address - Street 1:37677 PROFESSIONAL CENTER DR
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1192
Practice Address - Country:US
Practice Address - Phone:734-591-6277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011060101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health