Provider Demographics
NPI:1851347629
Name:STOREN, YVETTE G (LMSW)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:G
Last Name:STOREN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29924 UTICA RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4639
Mailing Address - Country:US
Mailing Address - Phone:586-435-4848
Mailing Address - Fax:
Practice Address - Street 1:279 N GROESBECK HWY
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-1546
Practice Address - Country:US
Practice Address - Phone:586-627-0024
Practice Address - Fax:586-627-0027
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801081823101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
N47440004Medicare PIN