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NPI Code Detail

MEDICARE: MRS. LORI KRISTINE CLEVELAND BS, LADC

MEDICARE: MRS. LORI KRISTINE CLEVELAND BS, LADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor401NE

General Provider Information

NPI Number : 1477691616
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LORI KRISTINE CLEVELAND BS, LADC
Provider Business Mailing Address
First Line : 2116 W FAIDLEY AVE
Second Line :
City : GRAND ISLAND
State : NE
Zip : 68803-4645
Country : US
Telephone Number : 308-398-5433
Fax Number : 308-398-5404
Provider Business Practice Location Address
First Line : 2116 W FAIDLEY AVE
Second Line :
City : GRAND ISLAND
State : NE
Zip : 68803-4645
Country : US
Telephone Number : 308-398-5433
Fax Number : 308-398-5404
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2007
Last Update Date : 07/08/2007

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