Provider Demographics
NPI:1205059219
Name:CLARA A. CLEVE
Entity type:Organization
Organization Name:CLARA A. CLEVE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR - PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLEVE
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW
Authorized Official - Phone:715-345-1965
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-0445
Mailing Address - Country:US
Mailing Address - Phone:715-345-1965
Mailing Address - Fax:715-254-0372
Practice Address - Street 1:1052 MAIN ST
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-2848
Practice Address - Country:US
Practice Address - Phone:715-345-1965
Practice Address - Fax:715-254-0372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WICERT NO. 1320251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39577700Medicaid
WI000088781Medicare ID - Type UnspecifiedFOR CLARA CLEVE
WI39577700Medicaid