Provider Demographics
NPI:1801516745
Name:MCCLOUD, JASMIN (LPC)
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:
Last Name:MCCLOUD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1248 SMITHWOOD DR APT A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1124
Mailing Address - Country:US
Mailing Address - Phone:201-247-6472
Mailing Address - Fax:
Practice Address - Street 1:1248 SMITHWOOD DR APT A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1124
Practice Address - Country:US
Practice Address - Phone:201-247-6472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00565800101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health