Provider Demographics
NPI:1437674900
Name:JUNIPER TREE LLC
Entity Type:Organization
Organization Name:JUNIPER TREE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:757-619-0658
Mailing Address - Street 1:1119 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-3610
Mailing Address - Country:US
Mailing Address - Phone:757-619-0658
Mailing Address - Fax:
Practice Address - Street 1:348 BROAD ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707
Practice Address - Country:US
Practice Address - Phone:757-619-0658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-07
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty