Provider Demographics
NPI:1558418293
Name:SNOW, E. FRED (LCPC)
Entity Type:Individual
Prefix:MR
First Name:E. FRED
Middle Name:
Last Name:SNOW
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5303 S POWERLINE RD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-8902
Mailing Address - Country:US
Mailing Address - Phone:208-468-0902
Mailing Address - Fax:208-330-1024
Practice Address - Street 1:1214 12TH AVE S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-4665
Practice Address - Country:US
Practice Address - Phone:208-468-0902
Practice Address - Fax:208-330-1024
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID81101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional