Provider Demographics
NPI:1548763725
Name:JUNIPER, JAMIE (CDCA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:JUNIPER
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 COLUMBUS RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-1334
Mailing Address - Country:US
Mailing Address - Phone:740-592-6724
Mailing Address - Fax:740-592-6728
Practice Address - Street 1:18 STATE ROUTE 143
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OH
Practice Address - Zip Code:45710-1100
Practice Address - Country:US
Practice Address - Phone:740-698-0131
Practice Address - Fax:740-698-0832
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH141723101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2864002Medicaid