Provider Demographics
NPI:1992343982
Name:JUNIPER TREE COUNSELING SVCS, LLC
Entity type:Organization
Organization Name:JUNIPER TREE COUNSELING SVCS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:DOROTHEA
Authorized Official - Last Name:PINCKNEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:843-534-8468
Mailing Address - Street 1:990 LAKE HUNTER CIR STE 202
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-5426
Mailing Address - Country:US
Mailing Address - Phone:843-881-4117
Mailing Address - Fax:843-881-1455
Practice Address - Street 1:990 LAKE HUNTER CIR STE 202
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-5426
Practice Address - Country:US
Practice Address - Phone:843-881-4117
Practice Address - Fax:843-881-1455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)