Provider Demographics
NPI:1548828387
Name:CLOUD, JILLEAN (MS, MFT-I)
Entity type:Individual
Prefix:
First Name:JILLEAN
Middle Name:
Last Name:CLOUD
Suffix:
Gender:F
Credentials:MS, MFT-I
Other - Prefix:
Other - First Name:JILLEAN
Other - Middle Name:
Other - Last Name:CLOUD-MACRORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3642 BOULDER HWY TRLR 259
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-1639
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2785 E DESERT INN RD STE 230
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3624
Practice Address - Country:US
Practice Address - Phone:702-836-3394
Practice Address - Fax:702-405-9250
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI1156106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist