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General NPI Number Information
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NPI Number | 1275632242
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Entity Type | Individual
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Provider Name | MARTIN ERVIN CLEVELAND PHD
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | BLANCHFIELD ARMY COMMUNITY HOSPITAL 650 JOEL DRIVE, BLDG E
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City | FORT CAMPBELL
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State | KY
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Zip | 42223-5349
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Country | US
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Telephone | 270-798-4097
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Fax |
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Provider Business Mailing Address
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Address Line | 5980 DESERT STORM AVE RM 33
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City | FORT CAMPBELL
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State | KY
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Zip | 42223-5514
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Country | US
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Telephone | 270-461-1563
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | P 1078
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License Number State | TN
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