Provider Demographics
NPI:1699041079
Name:SEMON, YVETTE RENEE (PCC-SUP)
Entity Type:Individual
Prefix:MS
First Name:YVETTE
Middle Name:RENEE
Last Name:SEMON
Suffix:
Gender:F
Credentials:PCC-SUP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23240 CHAGRIN BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5404
Mailing Address - Country:US
Mailing Address - Phone:216-292-6007
Mailing Address - Fax:216-292-7352
Practice Address - Street 1:23240 CHAGRIN BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44122-5404
Practice Address - Country:US
Practice Address - Phone:216-292-6007
Practice Address - Fax:216-292-7352
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 0004024101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional