Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ND |
NPI | 1558907956 |
---|---|
Provider Name | Chancey Allen Snyder |
First Address | Fargo, ND 58103-2119 |
Second Address | Fargo, ND 58103-2119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2019 |
Last Update Date | 20/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
502363652 | (05) | ND |