Provider Demographics
NPI:1528196375
Name:SNYDER, KELLY L (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:SNYDER
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2966 LYLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:TN
Mailing Address - Zip Code:37191-8206
Mailing Address - Country:US
Mailing Address - Phone:931-472-9102
Mailing Address - Fax:
Practice Address - Street 1:6000 RAMSEY WAY
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2198
Practice Address - Country:US
Practice Address - Phone:615-446-3797
Practice Address - Fax:615-446-5852
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4843101YP2500X
101Y00000X, 390200000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No171M00000XOther Service ProvidersCase Manager/Care Coordinator