Provider Demographics
NPI:1952476814
Name:VERNON, JAMES PATRICK (PCC-S, LCDC III)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:PATRICK
Last Name:VERNON
Suffix:
Gender:M
Credentials:PCC-S, LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24200 CHAGRIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5550
Mailing Address - Country:US
Mailing Address - Phone:440-263-1666
Mailing Address - Fax:
Practice Address - Street 1:24200 CHAGRIN BLVD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5550
Practice Address - Country:US
Practice Address - Phone:440-263-1666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 0002997101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
258943000OtherMAGELLAN
000000374352OtherANTHEM
95404OtherQUAL CHOICE