Provider Demographics
NPI:1295833820
Name:SNUGGERUD, DAWN KORMOS (LPCC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:KORMOS
Last Name:SNUGGERUD
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ROAD 6065
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-9605
Mailing Address - Country:US
Mailing Address - Phone:505-598-5892
Mailing Address - Fax:
Practice Address - Street 1:622 W MAPLE ST
Practice Address - Street 2:SUITE G
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6590
Practice Address - Country:US
Practice Address - Phone:505-325-2805
Practice Address - Fax:505-326-2557
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3310101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM24173Medicaid