MEDICARE: TINA LYNN CLEBERG

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	14045	TX
2	101YP2500X	Professional Counselor	80932	TX

General Provider Information

NPI Number	:	1841763588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA LYNN CLEBERG

Provider Business Mailing Address
First Line	:	1501C S WHEELER ST
Second Line	:
City	:	JASPER
State	:	TX
Zip	:	75951-5103
Country	:	US
Telephone Number	:	409-489-8299
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501C S WHEELER ST
Second Line	:
City	:	JASPER
State	:	TX
Zip	:	75951-5103
Country	:	US
Telephone Number	:	409-489-8299
Fax Number	:	409-397-9959

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

Provider Enumeration Date	:	01/04/2019
Last Update Date	:	04/12/2026

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Directions to “ TINA LYNN CLEBERG ” Practice Location

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