Healthcare Provider Details

I. General information

NPI: 1801724422
Provider Name (Legal Business Name): JUNIPER CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5748 N BROADWAY ST
KANSAS CITY MO
64118-3998
US

IV. Provider business mailing address

5748 N BROADWAY ST
KANSAS CITY MO
64118-3998
US

V. Phone/Fax

Practice location:
  • Phone: 913-214-2838
  • Fax:
Mailing address:
  • Phone: 913-214-2838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LISA MARIN
Title or Position: THERAPIST
Credential: LCSW
Phone: 913-213-8331