Provider Demographics
NPI:1679342067
Name:SNYDER, KEVIN R (PLMHP)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:SNYDER
Suffix:
Gender:M
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9373 S BASCOM DR
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:NE
Mailing Address - Zip Code:68876-9795
Mailing Address - Country:US
Mailing Address - Phone:308-216-0605
Mailing Address - Fax:
Practice Address - Street 1:412 W 48TH ST STE 4
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-1224
Practice Address - Country:US
Practice Address - Phone:308-216-0605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13732101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health