Organization
SHIFTING TIDES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TODD SNYDER PSY.D. (OPERATING MEMBER)
(219) 763-1499
Entity
Organization
Contact information
Practice address
6337 CENTRAL AVE, PORTAGE, IN 46368-3801
(219) 763-1499
(219) 764-7025
Mailing address
6337 CENTRAL AVE, PORTAGE, IN 46368-3801
(219) 763-1499
(219) 764-7025
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20042029A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200538700B
—
IN
Enumeration date
02/27/2009
Last updated
02/27/2009
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