Provider Demographics
NPI:1841936002
Name:JUNIPER COUNSELING COLLECTIVE
Entity type:Organization
Organization Name:JUNIPER COUNSELING COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:DOMANN-SCHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMHC
Authorized Official - Phone:503-407-1740
Mailing Address - Street 1:5741 NE GLISAN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-3793
Mailing Address - Country:US
Mailing Address - Phone:503-218-3631
Mailing Address - Fax:
Practice Address - Street 1:5741 NE GLISAN ST STE 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-3793
Practice Address - Country:US
Practice Address - Phone:503-218-3631
Practice Address - Fax:971-266-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty