MEDICARE: JEROME R CLELAND

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	106H00000X	Marriage & Family Therapist		CA

General Provider Information

NPI Number	:	1255260170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEROME R CLELAND

Provider Business Mailing Address
First Line	:	602 GALLAND ST
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-2717
Country	:	US
Telephone Number	:	858-205-7578
Fax Number	:

Provider Business Practice Location Address
First Line	:	602 GALLAND ST
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-2717
Country	:	US
Telephone Number	:	858-205-7578
Fax Number	:

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

Provider Enumeration Date	:	05/16/2026
Last Update Date	:	05/16/2026

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Directions to “ JEROME R CLELAND ” Practice Location

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