Provider Demographics
NPI:1205470424
Name:SNOWBALL, PAUL (MED)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:SNOWBALL
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 LATIMORE RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5022
Mailing Address - Country:US
Mailing Address - Phone:216-849-6150
Mailing Address - Fax:216-759-4898
Practice Address - Street 1:5851 PEARL RD STE 305
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-2112
Practice Address - Country:US
Practice Address - Phone:440-845-9011
Practice Address - Fax:440-845-9013
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-0002025-S101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health