Provider Demographics
NPI:1255857959
Name:JUNIPER HEALTH & WELLNESS LLC
Entity Type:Organization
Organization Name:JUNIPER HEALTH & WELLNESS LLC
Other - Org Name:CLEARWATER ABA, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:DR
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DBH, BCBA, LBA
Authorized Official - Phone:254-294-4488
Mailing Address - Street 1:2904 E STAN SCHLUETER LOOP # 70
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-4813
Mailing Address - Country:US
Mailing Address - Phone:254-294-4488
Mailing Address - Fax:512-367-5738
Practice Address - Street 1:207 W AVENUE D STE A
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-5263
Practice Address - Country:US
Practice Address - Phone:254-294-4488
Practice Address - Fax:512-367-5738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-16-24598103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2554OtherTEXAS STATE LICENSURE