Provider Demographics
NPI:1225453814
Name:JUNIPER MOUNTAIN COUNSELING
Entity Type:Organization
Organization Name:JUNIPER MOUNTAIN COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CLINIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MOCKAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS,MS, LPC
Authorized Official - Phone:541-617-0543
Mailing Address - Street 1:371 SW UPPER TERRACE DR STE 4
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1560
Mailing Address - Country:US
Mailing Address - Phone:541-617-0543
Mailing Address - Fax:541-617-0377
Practice Address - Street 1:371 SW UPPER TERRACE DR STE 4
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1560
Practice Address - Country:US
Practice Address - Phone:541-617-0543
Practice Address - Fax:541-617-0377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health