Healthcare Provider Details

I. General information

NPI: 1104245133
Provider Name (Legal Business Name): JAMES CLEMENT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15301 WARREN SHINGLE RD
BEALE AFB CA
95903-1905
US

IV. Provider business mailing address

24077 STATE HIGHWAY 49
NEVADA CITY CA
95959-8519
US

V. Phone/Fax

Practice location:
  • Phone: 530-634-3420
  • Fax:
Mailing address:
  • Phone: 530-265-9057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number103787
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 73218
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: