Healthcare Provider Details

I. General information

NPI: 1508263351
Provider Name (Legal Business Name): JUNIPER FAMILY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 E EXECUTIVE PARK DR STE E
MURRAY UT
84117-3581
US

IV. Provider business mailing address

925 E EXECUTIVE PARK DR STE E
MURRAY UT
84117-3581
US

V. Phone/Fax

Practice location:
  • Phone: 801-904-2284
  • Fax:
Mailing address:
  • Phone: 801-904-2284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DANIEL ELDREDGE
Title or Position: LCSW / OWNER
Credential:
Phone: 801-904-2284