Provider Demographics
NPI:1740321009
Name:SNOW, JAN D (LPC)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:D
Last Name:SNOW
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6199 W STATE HIGHWAY 56
Mailing Address - Street 2:
Mailing Address - City:SAVOY
Mailing Address - State:TX
Mailing Address - Zip Code:75479-3819
Mailing Address - Country:US
Mailing Address - Phone:903-815-6791
Mailing Address - Fax:
Practice Address - Street 1:112 W 5TH ST
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-4365
Practice Address - Country:US
Practice Address - Phone:903-583-4339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12711101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170463701Medicaid