=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366233470
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUNIPER GROUP CO, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2025
-----------------------------------------------------
Last Update Date | 05/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3570 DEXTER ANN ARBOR RD
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48103-1619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-277-4577
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2531 JACKSON AVE # 146
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48103-3818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-277-4577
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. JENNIFER ELAINE MITCHELL
-----------------------------------------------------
Credential | LPC, CCS, CAADC
-----------------------------------------------------
Telephone | 734-277-4577
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------