MEDICARE: CLEVELAND MITCHNER

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1447590153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLEVELAND MITCHNER

Provider Business Mailing Address
First Line	:	3117 W DIXIE BLVD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34946-1721
Country	:	US
Telephone Number	:	772-828-7167
Fax Number	:

Provider Business Practice Location Address
First Line	:	3117 W DIXIE BLVD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34946-1721
Country	:	US
Telephone Number	:	772-828-7167
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2013
Last Update Date	:	02/18/2013

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Directions to “ CLEVELAND MITCHNER ” Practice Location

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