Provider Demographics
NPI:1043047632
Name:MCPHERSON, TREVONNA
Entity type:Individual
Prefix:
First Name:TREVONNA
Middle Name:
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30841 EUCLID AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-3100
Mailing Address - Country:US
Mailing Address - Phone:216-441-2496
Mailing Address - Fax:
Practice Address - Street 1:30841 EUCLID AVE STE 102
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-3100
Practice Address - Country:US
Practice Address - Phone:216-441-2496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.189849171M00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator