Provider Demographics
NPI:1710520648
Name:MATTHEWS, CLEAVON PENDELL (LPC)
Entity Type:Individual
Prefix:
First Name:CLEAVON
Middle Name:PENDELL
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7644 BRAMS HILL DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4124
Mailing Address - Country:US
Mailing Address - Phone:937-529-9073
Mailing Address - Fax:
Practice Address - Street 1:7644 BRAMS HILL DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4124
Practice Address - Country:US
Practice Address - Phone:937-529-9073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801453101YM0800X
OHE.2303973101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health