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NPI Code Detail

MEDICARE: LEEVI GRANT CLUTTER

MEDICARE: LEEVI GRANT CLUTTER
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
1175T00000XPeer Specialist26-901MHWV

General Provider Information

NPI Number : 1518851757
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEEVI GRANT CLUTTER
Provider Business Mailing Address
First Line : 180 WELLNESS DR
Second Line :
City : SUMMERSVILLE
State : WV
Zip : 26651-5401
Country : US
Telephone Number : 304-872-0058
Fax Number : 304-872-0116
Provider Business Practice Location Address
First Line : 180 WELLNESS DR
Second Line :
City : SUMMERSVILLE
State : WV
Zip : 26651-5401
Country : US
Telephone Number : 304-872-0058
Fax Number : 304-872-0116
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2025
Last Update Date : 02/03/2026

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Directions to “ LEEVI GRANT CLUTTER ” Practice Location

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