Provider Demographics
NPI:1942356217
Name:THE JUNIPER CLINIC, LLC
Entity Type:Organization
Organization Name:THE JUNIPER CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-448-9466
Mailing Address - Street 1:916 N WEBER ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2921
Mailing Address - Country:US
Mailing Address - Phone:719-448-9466
Mailing Address - Fax:719-448-9467
Practice Address - Street 1:916 N WEBER ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-2921
Practice Address - Country:US
Practice Address - Phone:719-448-9466
Practice Address - Fax:719-448-9467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health