Provider Demographics
NPI:1972669471
Name:SNYDER, GREGORY S (PHD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:S
Last Name:SNYDER
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 1:18021 OAK ST STE B
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-6035
Mailing Address - Country:US
Mailing Address - Phone:402-986-6250
Mailing Address - Fax:402-702-1584
Practice Address - Street 1:18021 OAK ST STE B
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-6035
Practice Address - Country:US
Practice Address - Phone:402-986-6250
Practice Address - Fax:402-702-1584
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE678103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026522505Medicaid
NE47037660631Medicaid
NE470376606-24Medicaid