Provider Demographics
NPI:1225292212
Name:YATES-BOURG, EMMA LOUISE (LPCC)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:LOUISE
Last Name:YATES-BOURG
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:LOUISE
Other - Last Name:YATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:20525 CENTER RIDGE RD
Mailing Address - Street 2:STE 365
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3437
Mailing Address - Country:US
Mailing Address - Phone:866-466-9591
Mailing Address - Fax:216-712-6313
Practice Address - Street 1:20525 CENTER RIDGE RD
Practice Address - Street 2:STE 365
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3437
Practice Address - Country:US
Practice Address - Phone:866-466-9591
Practice Address - Fax:216-712-6313
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-3986101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional