Provider Demographics
NPI:1982953980
Name:CLEVELAND, SHARLEY J (LIMHP, LADC)
Entity Type:Individual
Prefix:
First Name:SHARLEY
Middle Name:J
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:LIMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E 2ND ST STE 10
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5474
Mailing Address - Country:US
Mailing Address - Phone:308-660-9242
Mailing Address - Fax:308-534-5749
Practice Address - Street 1:109 E 2ND ST STE 10
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5474
Practice Address - Country:US
Practice Address - Phone:308-660-9242
Practice Address - Fax:308-534-5749
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1452101YM0800X
NE1104101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026442500Medicaid