Provider Demographics
NPI:1356980049
Name:CLEVELAND, JARVIS T (LMSW)
Entity type:Individual
Prefix:
First Name:JARVIS
Middle Name:T
Last Name:CLEVELAND
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 OFFICE PARK CIR STE 102
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2519
Mailing Address - Country:US
Mailing Address - Phone:205-639-8081
Mailing Address - Fax:
Practice Address - Street 1:14 OFFICE PARK CIR STE 102
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-2519
Practice Address - Country:US
Practice Address - Phone:205-639-8081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4887G101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL832197896Medicaid