Provider Demographics
NPI:1801190624
Name:SNYDER, KIMBERLY ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:SNYDER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-4908
Mailing Address - Country:US
Mailing Address - Phone:602-857-9797
Mailing Address - Fax:623-745-4997
Practice Address - Street 1:12725 W INDIAN SCHOOL ROAD E-101
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-9502
Practice Address - Country:US
Practice Address - Phone:602-857-9797
Practice Address - Fax:602-745-4997
Is Sole Proprietor?:No
Enumeration Date:2011-01-08
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-004017103TC0700X
AZ4017103TC0700X
103TP2701X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral