Provider Demographics
NPI:1801239538
Name:COLON-PEREZ, LISSETTE MARIE (LPCC-S)
Entity type:Individual
Prefix:MRS
First Name:LISSETTE
Middle Name:MARIE
Last Name:COLON-PEREZ
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:MS
Other - First Name:LISSETTE
Other - Middle Name:MARIE
Other - Last Name:COLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC-S
Mailing Address - Street 1:5445 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-2026
Mailing Address - Country:US
Mailing Address - Phone:216-453-1112
Mailing Address - Fax:216-662-6643
Practice Address - Street 1:2882 CRICKET LN
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44092-1412
Practice Address - Country:US
Practice Address - Phone:440-347-0716
Practice Address - Fax:440-347-0717
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0800476101YP2500X
OHE.0800476-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional