| Doctor Name: | MR. EDGAR JEROME SNIDER |
| NPI Number: | 1679859870 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.P.C. |
| License Number: | 2546 |
| Business Practice Address: | 35232 Ew 1380 Konawa, OK - 748492309 |
| Business Phone Number: | 5809252127 |
| Business Fax Number: | 5809252127 |
| Mailing Address: | 35232 Cr Ew 1380, KONAWA |
| State: | OK |
| Postal Code: | 74849 |
| Phone Number: | 5809252127 |
| Fax Number: | 5809252127 |
| NPI Enumeration Date: | 11/01/2011 |
| NPI Last Update Date: | 11/01/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2546 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |