Provider Demographics
NPI:1740594126
Name:JUNEAU KEESE, JENNIFER R (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:R
Last Name:JUNEAU KEESE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:R
Other - Last Name:JUNEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:PO BOX 743052
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75374-3052
Mailing Address - Country:US
Mailing Address - Phone:971-282-1872
Mailing Address - Fax:888-237-2214
Practice Address - Street 1:575 N VALLEY PKWY STE 220
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3437
Practice Address - Country:US
Practice Address - Phone:972-282-1872
Practice Address - Fax:888-237-2214
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1 07 3834103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst