Provider Demographics
NPI:1528475910
Name:CLEVELAND, KATHY ANN (BST WORKER)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:BST WORKER
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:ANN
Other - Last Name:CLEVELAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BST WORKER
Mailing Address - Street 1:4103 HARMONY POINT DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-6106
Mailing Address - Country:US
Mailing Address - Phone:702-600-9905
Mailing Address - Fax:702-445-6354
Practice Address - Street 1:2480 N DECATUR BLVD STE 125
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-2985
Practice Address - Country:US
Practice Address - Phone:702-445-6350
Practice Address - Fax:702-445-6354
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health