Jeremiah Thomas Cleveland
Individual provider Active NPI Counselor · Wagoner, OK
NPI 1649869579 · NPPES record last updated Jan 14, 2021
Key facts
- NPI
- 1649869579
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 109 S Harrill Ave
Wagoner, OK 74467-5317 - Phone
- (918) 370-4922
- NPI assigned
- Jan 14, 2021
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
109 S Harrill Ave
Wagoner, OK 74467-5317
Mailing address
109 S Harrill Ave
Wagoner, OK 74467-5317
Phone (918) 370-4922
Other providers in Wagoner, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 14, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.