Individual
SHARON CLEVELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.C.P.C.
Contact information
Practice address
834 FALLS AVE STE 1280, TWIN FALLS, ID 83301-3364
(208) 736-9990
(208) 736-9995
Mailing address
80 SUNNYSIDE DR, JEROME, ID 83338-5972
(208) 324-1120
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0011848
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010003974
BLUE SHIELD
ID
01
—
481086633
TAX IDENTIFICATION NUMBER
ID
05
—
805997100
—
ID
01
—
X5663
BLU CROSS
ID
Enumeration date
04/11/2007
Last updated
07/01/2016
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