Provider Demographics
NPI:1174041628
Name:CLEVELAND, MERVIN LEIGH JR (LPC)
Entity Type:Individual
Prefix:MR
First Name:MERVIN
Middle Name:LEIGH
Last Name:CLEVELAND
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:MERVIN
Other - Middle Name:LEIGH
Other - Last Name:CLEVELAND
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:P.O. BOX 1883
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340
Mailing Address - Country:US
Mailing Address - Phone:936-581-4274
Mailing Address - Fax:
Practice Address - Street 1:3010 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-6022
Practice Address - Country:US
Practice Address - Phone:936-581-4274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71508101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty