Healthcare Provider Details

I. General information

NPI: 1386574762
Provider Name (Legal Business Name): JACQULINE CLEROU
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: JAY CLEROU

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 10TH ST
SANTA MONICA CA
90403-2956
US

IV. Provider business mailing address

921 10TH ST APT 212
SANTA MONICA CA
90403-2931
US

V. Phone/Fax

Practice location:
  • Phone: 661-706-7037
  • Fax:
Mailing address:
  • Phone: 661-706-7037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number141418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: