Provider Demographics
NPI:1821597907
Name:PREVETT, DANIELLE (LPCC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:PREVETT
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24600 CENTER RIDGE RD STE 130
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5679
Mailing Address - Country:US
Mailing Address - Phone:440-452-0967
Mailing Address - Fax:
Practice Address - Street 1:24600 CENTER RIDGE RD STE 130
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5679
Practice Address - Country:US
Practice Address - Phone:440-452-0967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2102377101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0323851Medicaid