MEDICARE: JAIMIE N CLOUD LMFT

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	101YM0800X	Mental Health Counselor
2	106H00000X	Marriage & Family Therapist		CA

General Provider Information

NPI Number	:	1326319427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIMIE N CLOUD LMFT

Provider Business Mailing Address
First Line	:	3359 CHICAGO AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-6820
Country	:	US
Telephone Number	:	951-900-4414
Fax Number	:

Provider Business Practice Location Address
First Line	:	3359 CHICAGO AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-6820
Country	:	US
Telephone Number	:	951-900-4414
Fax Number	:

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

Provider Enumeration Date	:	01/20/2012
Last Update Date	:	01/29/2019

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