Provider Demographics
NPI:1528710381
Name:JUNIPER HOLISTIC MENTAL HEALTH, PLLC
Entity type:Organization
Organization Name:JUNIPER HOLISTIC MENTAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:EVERETT
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:603-460-5675
Mailing Address - Street 1:190 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-2716
Mailing Address - Country:US
Mailing Address - Phone:603-460-5675
Mailing Address - Fax:
Practice Address - Street 1:190 ELM ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-2716
Practice Address - Country:US
Practice Address - Phone:603-460-5675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty