MEDICARE: JUNIPER FAMILY COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1497172746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUNIPER FAMILY COUNSELING

Provider Business Mailing Address
First Line	:	925 E EXECUTIVE PARK DR STE E
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84117-3542
Country	:	US
Telephone Number	:	801-904-2284
Fax Number	:

Provider Business Practice Location Address
First Line	:	925 E EXECUTIVE PARK DR STE E
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84117-3542
Country	:	US
Telephone Number	:	801-904-2284
Fax Number	:

Authorized Official
Title or Position	:	OWNER/LCSW
Name	:	DANIEL ELDREDGE
Credential	:
Telephone Number	:	801-904-2284

Provider Enumeration Date	:	03/25/2014
Last Update Date	:	03/25/2014

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Directions to “JUNIPER FAMILY COUNSELING ” Practice Location

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