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General NPI Number Information
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NPI Number | 1760016299
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Entity Type | Organization
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Legal Business Name | TRIBE513, P.A.
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Dates
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Enumeration Date | 02/24/2020
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Last Update Date | 04/19/2024
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Provider Practice Location Address
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Address Line | 127 W ANTRIM DR
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City | GREENVILLE
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State | SC
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Zip | 29607-2505
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Country | US
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Telephone | 864-239-4110
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Fax |
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Provider Business Mailing Address
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Address Line | 127 W ANTRIM DR
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City | GREENVILLE
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State | SC
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Zip | 29607-2505
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Country | US
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Telephone | 864-239-4110
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JENNIE CLEVELAND
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Credential |
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Telephone | 970-471-2922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TE1100X
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Taxonomy Name | Exercise & Sports Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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