Provider Demographics
NPI:1992081442
Name:SNODGRASS, JERRY JAY (LPC)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:JAY
Last Name:SNODGRASS
Suffix:
Gender:M
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:PO BOX 581
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97528-0049
Mailing Address - Country:US
Mailing Address - Phone:541-295-2363
Mailing Address - Fax:541-295-8254
Practice Address - Street 1:432 NW 6TH ST STE 206
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2054
Practice Address - Country:US
Practice Address - Phone:541-295-2363
Practice Address - Fax:541-295-8254
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2311101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional