Provider Demographics
NPI:1144732116
Name:CLEVELAND, TAMARO HUDSON (LPC)
Entity type:Individual
Prefix:MRS
First Name:TAMARO
Middle Name:HUDSON
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 941
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:LA
Mailing Address - Zip Code:71232-0941
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:615 EE WALLACE BLVD S
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334-3224
Practice Address - Country:US
Practice Address - Phone:318-757-9363
Practice Address - Fax:318-757-9364
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-31
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 171M00000X
LA7388101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator