MEDICARE: MRS. BENITA WHITAKER CLEVELAND M. ED

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	175T00000X	Peer Specialist	51324-0125	TX
2	101YA0400X	Addiction (Substance Use Disorder) Counselor		TX
3	101YS0200X	School Counselor		TX

General Provider Information

NPI Number	:	1982430427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BENITA WHITAKER CLEVELAND M. ED

Provider Business Mailing Address
First Line	:	1009 COLVIN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-6813
Country	:	US
Telephone Number	:	817-228-7540
Fax Number	:

Provider Business Practice Location Address
First Line	:	1009 COLVIN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-6813
Country	:	US
Telephone Number	:	817-228-7540
Fax Number	:

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

Provider Enumeration Date	:	09/11/2024
Last Update Date	:	06/22/2026

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