Provider Demographics
NPI:1821008665
Name:CLEVELAND, CHARLES TRACY (PHD PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:TRACY
Last Name:CLEVELAND
Suffix:
Gender:M
Credentials:PHD PSYCHOLOGIST
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Mailing Address - Street 1:2211 NORFOLK
Mailing Address - Street 2:STE 140
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098
Mailing Address - Country:US
Mailing Address - Phone:713-398-5303
Mailing Address - Fax:713-729-7652
Practice Address - Street 1:2211 NORFOLK
Practice Address - Street 2:STE 140
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098
Practice Address - Country:US
Practice Address - Phone:713-398-5303
Practice Address - Fax:713-729-7652
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX22369103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00183EMedicare ID - Type Unspecified