Provider Demographics
NPI:1356113716
Name:CLEARWATER, JENNIFER (AMFT, APCC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:CLEARWATER
Suffix:
Gender:F
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 814
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-0814
Mailing Address - Country:US
Mailing Address - Phone:916-415-8421
Mailing Address - Fax:
Practice Address - Street 1:214 ESTATES DR STE E
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2353
Practice Address - Country:US
Practice Address - Phone:916-581-0054
Practice Address - Fax:016-244-0252
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14977101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health