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General NPI Number Information
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NPI Number | 1265872949
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Entity Type | Organization
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Legal Business Name | SHETTRA SNOWBALL PLLC
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Dates
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Enumeration Date | 06/26/2013
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Last Update Date | 06/26/2013
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Provider Practice Location Address
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Address Line | 6400 N CAROL DR
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City | OKLAHOMA CITY
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State | OK
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Zip | 73141-9623
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Country | US
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Telephone | 405-642-3278
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Fax | 405-771-9184
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Provider Business Mailing Address
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Address Line | 6400 N CAROL DR
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City | OKLAHOMA CITY
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State | OK
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Zip | 73141-9623
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Country | US
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Telephone | 405-642-3278
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Fax | 405-771-9184
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MRS. SHETTRA MICHELLE SNOWBALL
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Credential | LCSW
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Telephone | 405-642-3278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3876
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License Number State | OK
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