Provider Demographics
NPI:1841763588
Name:CLEBERG, TINA LYNN
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:LYNN
Last Name:CLEBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501C S WHEELER ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-5103
Mailing Address - Country:US
Mailing Address - Phone:409-489-8299
Mailing Address - Fax:
Practice Address - Street 1:1501C S WHEELER ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-5103
Practice Address - Country:US
Practice Address - Phone:409-489-8299
Practice Address - Fax:409-397-9959
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14045101YA0400X
TX80932101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)