Provider Demographics
NPI:1679859870
Name:SNIDER, EDGAR JEROME (LPC)
Entity Type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:JEROME
Last Name:SNIDER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35232 CR EW 1380
Mailing Address - Street 2:
Mailing Address - City:KONAWA
Mailing Address - State:OK
Mailing Address - Zip Code:74849
Mailing Address - Country:US
Mailing Address - Phone:580-925-2127
Mailing Address - Fax:580-925-2127
Practice Address - Street 1:35232 EW 1380
Practice Address - Street 2:
Practice Address - City:KONAWA
Practice Address - State:OK
Practice Address - Zip Code:74849-2309
Practice Address - Country:US
Practice Address - Phone:580-925-2127
Practice Address - Fax:580-925-2127
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2546101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional