Provider Demographics
NPI:1962850941
Name:SNIDER, REBECCA (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SNIDER
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9621 E 450 N
Mailing Address - Street 2:
Mailing Address - City:PIERCETON
Mailing Address - State:IN
Mailing Address - Zip Code:46562-9733
Mailing Address - Country:US
Mailing Address - Phone:574-238-0839
Mailing Address - Fax:
Practice Address - Street 1:10808 LA CABREAH LN
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-2100
Practice Address - Country:US
Practice Address - Phone:574-238-0839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002260A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health