Provider Demographics
NPI:1881656874
Name:SEMIVAN, JERRY E (MSED, LPCC)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:E
Last Name:SEMIVAN
Suffix:
Gender:M
Credentials:MSED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 WINDHAM CT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5035
Mailing Address - Country:US
Mailing Address - Phone:330-884-1900
Mailing Address - Fax:330-884-1928
Practice Address - Street 1:955 WINDHAM CT
Practice Address - Street 2:SUITE 2
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5035
Practice Address - Country:US
Practice Address - Phone:330-884-1900
Practice Address - Fax:330-884-1928
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0001311101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health