Healthcare Provider Details

I. General information

NPI: 1568910974
Provider Name (Legal Business Name): JONATHAN CLEVELAND PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 POE AVE STE 400
DAYTON OH
45414-2527
US

IV. Provider business mailing address

425 N FINDLAY ST
DAYTON OH
45404-2287
US

V. Phone/Fax

Practice location:
  • Phone: 937-276-3356
  • Fax:
Mailing address:
  • Phone: 937-716-7663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7473
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: