Provider Demographics
NPI:1780493783
Name:CLEVELAND, LYNDEE NICOLE (LM, CPM)
Entity type:Individual
Prefix:
First Name:LYNDEE
Middle Name:NICOLE
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 MCKEE CT
Mailing Address - Street 2:
Mailing Address - City:FATE
Mailing Address - State:TX
Mailing Address - Zip Code:75087-6783
Mailing Address - Country:US
Mailing Address - Phone:469-878-2006
Mailing Address - Fax:
Practice Address - Street 1:675 MCKEE CT
Practice Address - Street 2:
Practice Address - City:FATE
Practice Address - State:TX
Practice Address - Zip Code:75087-6783
Practice Address - Country:US
Practice Address - Phone:469-878-2006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99585261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local