Provider Demographics
NPI:1972874717
Name:YERGIN, COURTNEY JOELLE (LSW)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:JOELLE
Last Name:YERGIN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 HARPER RD
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-1554
Mailing Address - Country:US
Mailing Address - Phone:440-223-6014
Mailing Address - Fax:
Practice Address - Street 1:5111 HARPER RD
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-1554
Practice Address - Country:US
Practice Address - Phone:440-223-6014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1100298104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker