Provider Demographics
NPI:1629310461
Name:CLEVELAND, SUSAN ELIZABETH (MA, NCC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 KING SALMON PL
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97121-9777
Mailing Address - Country:US
Mailing Address - Phone:541-263-2185
Mailing Address - Fax:
Practice Address - Street 1:921 14TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2316
Practice Address - Country:US
Practice Address - Phone:360-423-0203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health