Healthcare Provider Details

I. General information

NPI: 1366355828
Provider Name (Legal Business Name): LATANYA M EMERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANYA EMERSON

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 CORPORATE WAY STE 800A
WESTLAKE OH
44145-1569
US

IV. Provider business mailing address

28031 COOLIDGE DR
EUCLID OH
44132-3507
US

V. Phone/Fax

Practice location:
  • Phone: 575-449-7171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberS2614195
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: