Provider Demographics
NPI:1518985662
Name:CLEMENS, JEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:
Last Name:CLEMENS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1566 AALBORG CT
Mailing Address - Street 2:
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93463-2000
Mailing Address - Country:US
Mailing Address - Phone:805-350-1631
Mailing Address - Fax:805-688-4485
Practice Address - Street 1:540 ALISAL RD
Practice Address - Street 2:SUITE 3
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-2637
Practice Address - Country:US
Practice Address - Phone:805-350-1631
Practice Address - Fax:805-688-4485
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9240103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical