Provider Demographics
NPI:1215562285
Name:CLEVELAND, CHRIS P (CSW)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:P
Last Name:CLEVELAND
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8205 SPAIN RD NE STE 106
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3155
Mailing Address - Country:US
Mailing Address - Phone:505-856-0300
Mailing Address - Fax:505-856-7946
Practice Address - Street 1:8205 SPAIN RD NE STE 106
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3155
Practice Address - Country:US
Practice Address - Phone:505-856-0300
Practice Address - Fax:505-856-7946
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator