Individual provider Active NPI

Jennifer Cleveland, PHD

  • Counseling Psychologist
  • San Antonio, TX
National Provider Identifier
1003946310
Registry record updated Nov 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
38400 Issued in TX
Practice address
614 Walnut Hill St
San Antonio, TX 78232-2713
Phone
(917) 774-1335
NPI assigned
Mar 6, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling Psychologist 103TC1900X 014827 NY
Counseling Psychologist 103TC1900X 489700 NJ
Counseling Psychologist 103TC1900X 38400 TX Primary

Addresses

Primary practice location

614 Walnut Hill St
San Antonio, TX 78232-2713

Mailing address

614 Walnut Hill St
San Antonio, TX 78232-2713
Phone (917) 774-1335

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
489700NJMDCounseling Psychologist
38400TXMDCounseling Psychologist
1062KSMDMarriage & Family Therapist
014827NYMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sun Psychological CurrentSince Nov 28, 2021 Accepting new patients
Montefiore Medical Center Past Accepting new patients
Montefiore Medical Center Past Accepting new patients
South Central Mental Health Counseling Center, Inc. Past Accepting new patients
South Central Mental Health Counseling Center, Inc. PastSince Dec 3, 2023 Accepting new patients

Locations

1901 NW Military Hwy
Ste 112
San Antonio, TX 78213
Phone (201) 864-6124

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606089600000",
    "number": "1003946310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "614 WALNUT HILL ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782322713",
            "telephone_number": "917-774-1335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "614 WALNUT HILL ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782322713",
            "telephone_number": "917-774-1335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEVELAND",
        "first_name": "JENNIFER",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-06",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "NY",
            "license": "014827",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "NJ",
            "license": "489700",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "TX",
            "license": "38400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.