Provider Demographics
NPI:1306338926
Name:SNYDER, VICKY A (LASAC, LPC)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:A
Last Name:SNYDER
Suffix:
Gender:F
Credentials:LASAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8644 W PEORIA AVE, SUITE 6
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345
Mailing Address - Country:US
Mailing Address - Phone:602-507-7595
Mailing Address - Fax:602-429-8154
Practice Address - Street 1:8466 W PEORIA AVE STE 6
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345
Practice Address - Country:US
Practice Address - Phone:602-507-7595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13323101YA0400X
101YP2500X
AZ17570101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ473197Medicaid