Provider Demographics
NPI:1447572813
Name:CLEVELAND, MARILYNN S (MED)
Entity Type:Individual
Prefix:MS
First Name:MARILYNN
Middle Name:S
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 S COMMERCE ST
Mailing Address - Street 2:BUILDING B
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-5519
Mailing Address - Country:US
Mailing Address - Phone:580-223-5636
Mailing Address - Fax:580-226-6727
Practice Address - Street 1:909 ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-5229
Practice Address - Country:US
Practice Address - Phone:580-223-5636
Practice Address - Fax:580-226-6727
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health