Provider Demographics
NPI:1861960650
Name:ARISS, TARESSA SNYDER
Entity type:Individual
Prefix:
First Name:TARESSA
Middle Name:SNYDER
Last Name:ARISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TARESSA
Other - Middle Name:CHRISTINA
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5775 GREEN RD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-9218
Mailing Address - Country:US
Mailing Address - Phone:517-231-9687
Mailing Address - Fax:
Practice Address - Street 1:5775 GREEN RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-9218
Practice Address - Country:US
Practice Address - Phone:517-231-9687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI175T00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty