Basic Information
| Provider Information | |||||||||
| NPI: | 1790862001 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SNEED | ||||||||
| FirstName: | TED | ||||||||
| MiddleName: | G. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3328 W HORIZON AVE | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992088812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169668375 | ||||||||
| FaxNumber: | 5306222793 | ||||||||
| Practice Location | |||||||||
| Address1: | 17 E 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992021201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169668375 | ||||||||
| FaxNumber: | 3602535170 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 06/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PSY17786 | CA | N | Behavioral Health & Social Service Providers | Psychologist | 103TC0700X | PY60516246 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.