Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TC1900X | Counseling Psychologist | 014827 | NY |
Y | 103TC1900X | Counseling Psychologist | 38400 | TX |
N | 103TC1900X | Counseling Psychologist | 489700 | NJ |
NPI | 1003946310 |
---|---|
Provider Name | Jennifer Cleveland |
First Address | San Antonio, TX 78232-2713 |
Second Address | San Antonio, TX 78232-2713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 23/11/2020 |