Provider Demographics
NPI:1770220451
Name:SNIDER, TAYLOR ELIZABETH (LPC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ELIZABETH
Last Name:SNIDER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:ELIZABETH
Other - Last Name:DIMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 NW 142ND ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1924
Mailing Address - Country:US
Mailing Address - Phone:580-861-2171
Mailing Address - Fax:
Practice Address - Street 1:1402 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-5814
Practice Address - Country:US
Practice Address - Phone:405-533-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10756101YP2500X
261QC1500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health