Provider Demographics
NPI:1174161004
Name:CLIFTON, JARRETT JEMALE (LEP)
Entity type:Individual
Prefix:MR
First Name:JARRETT
Middle Name:JEMALE
Last Name:CLIFTON
Suffix:
Gender:M
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 E DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4514
Mailing Address - Country:US
Mailing Address - Phone:760-503-5234
Mailing Address - Fax:
Practice Address - Street 1:270 E DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4514
Practice Address - Country:US
Practice Address - Phone:760-503-5234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP3974103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool