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General NPI Number Information
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NPI Number | 1356028625
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Entity Type | Organization
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Legal Business Name | JUNIPER COUNSELING PLLC
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Dates
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Enumeration Date | 06/29/2023
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 1075 RIVERWALK DRIVE SUITE 258
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City | IDAHO FALLS
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State | ID
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Zip | 83402
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Country | US
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Telephone | 208-201-3425
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Fax |
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Provider Business Mailing Address
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Address Line | 2758 E BROOKLYN ST
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City | AMMON
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State | ID
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Zip | 83401-1367
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Country | US
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Telephone | 208-201-3425
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | PHILLIP ASHTON
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Credential | LCSW
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Telephone | 208-201-3425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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