Provider Demographics
NPI:1336248079
Name:JOSELL, PAUL G (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:G
Last Name:JOSELL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5564 WILSON MILLS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3265
Mailing Address - Country:US
Mailing Address - Phone:440-461-1255
Mailing Address - Fax:440-461-1047
Practice Address - Street 1:675 ALPHA DR STE E
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-2139
Practice Address - Country:US
Practice Address - Phone:440-473-9695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5128103T00000X
OH5028103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2987424Medicaid
OH2987424Medicaid