Provider Demographics
NPI:1386018026
Name:SNODGRASS, MARY LOU (MFT)
Entity Type:Individual
Prefix:
First Name:MARY LOU
Middle Name:
Last Name:SNODGRASS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 CERES AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1471
Mailing Address - Country:US
Mailing Address - Phone:530-343-6265
Mailing Address - Fax:
Practice Address - Street 1:2345 CERES AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1471
Practice Address - Country:US
Practice Address - Phone:530-343-6265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 33804106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist