Provider Demographics
NPI:1972115608
Name:SNETHEN, COLTER (PSYD)
Entity Type:Individual
Prefix:
First Name:COLTER
Middle Name:
Last Name:SNETHEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 ENGLISH VILLAGE DR APT 102
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-2139
Mailing Address - Country:US
Mailing Address - Phone:816-305-6953
Mailing Address - Fax:
Practice Address - Street 1:6411 S EAST ST STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-2737
Practice Address - Country:US
Practice Address - Phone:317-780-5750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043325A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical