Provider Demographics
NPI:1912380692
Name:CLEVELAND, CAROLYN SIMS (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:SIMS
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 W 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3002
Mailing Address - Country:US
Mailing Address - Phone:509-201-1616
Mailing Address - Fax:844-755-6412
Practice Address - Street 1:400 E UNIVERSITY WAY
Practice Address - Street 2:STUDENT MEDICAL AND COUNSELING CLINIC
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-7502
Practice Address - Country:US
Practice Address - Phone:509-963-1391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60549017103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical