Healthcare Provider Details

I. General information

NPI: 1699534875
Provider Name (Legal Business Name): UNDER THE JUNIPER COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 EASTGATE DR STE B202
LOS ALAMOS NM
87544-3300
US

IV. Provider business mailing address

127 EASTGATE DR STE B202
LOS ALAMOS NM
87544-3300
US

V. Phone/Fax

Practice location:
  • Phone: 801-860-3457
  • Fax:
Mailing address:
  • Phone: 801-860-3457
  • 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: ANGELA C JOHNSON
Title or Position: OWNER
Credential: LCSW
Phone: 801-860-3457