Provider Demographics
NPI:1790862001
Name:SNEED, TED G (PHD)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:G
Last Name:SNEED
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 1:3328 W HORIZON AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-8812
Mailing Address - Country:US
Mailing Address - Phone:916-966-8375
Mailing Address - Fax:530-622-2793
Practice Address - Street 1:17 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1201
Practice Address - Country:US
Practice Address - Phone:916-966-8375
Practice Address - Fax:360-253-5170
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17786103T00000X
WAPY60516246103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL177860Medicare ID - Type UnspecifiedMEDICARE ID#