Provider Demographics
NPI:1619002516
Name:SNIDER, BRIAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:SNIDER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7608 E. 91ST. ST.
Mailing Address - Street 2:STE 212
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133
Mailing Address - Country:US
Mailing Address - Phone:918-492-2480
Mailing Address - Fax:918-492-8930
Practice Address - Street 1:7608 E 91ST ST
Practice Address - Street 2:STE 212
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6014
Practice Address - Country:US
Practice Address - Phone:918-492-2480
Practice Address - Fax:918-492-8930
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK913103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling