Healthcare Provider Details

I. General information

NPI: 1942356217
Provider Name (Legal Business Name): THE JUNIPER CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 N WEBER ST
COLORADO SPRINGS CO
80903-2921
US

IV. Provider business mailing address

916 N WEBER ST
COLORADO SPRINGS CO
80903-2921
US

V. Phone/Fax

Practice location:
  • Phone: 719-448-9466
  • Fax: 719-448-9467
Mailing address:
  • Phone: 719-448-9466
  • Fax: 719-448-9467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN HOUGH
Title or Position: PRESIDENT
Credential: PHD
Phone: 719-448-9466