Healthcare Provider Details

I. General information

NPI: 1841815677
Provider Name (Legal Business Name): JUNIPER WEST COUNSELING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58128 HIGHWAY 330 UNIT 6
COLLBRAN CO
81624-9502
US

IV. Provider business mailing address

PO BOX 193
COLLBRAN CO
81624-0193
US

V. Phone/Fax

Practice location:
  • Phone: 970-783-0340
  • Fax:
Mailing address:
  • Phone: 970-783-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: PAIGE MARVIN
Title or Position: OWNER/COUNSELOR
Credential: LPC
Phone: 970-783-0340