Basic Information
| Provider Information | |||||||||
| NPI: | 1689816738 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JUNTUNEN | ||||||||
| FirstName: | TAMRY | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | TAMRY JUNTUNEN | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | JUNTUNEN | ||||||||
| OtherFirstName: | TAMRY | ||||||||
| OtherMiddleName: | L | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | TAMRY JUNTUNEN | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 19019 VENTURA BLVD | ||||||||
| Address2: | |||||||||
| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913563253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183452345 | ||||||||
| FaxNumber: | 8187588015 | ||||||||
| Practice Location | |||||||||
| Address1: | 212 S MARION ST | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | OAK PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 603023159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083583000 | ||||||||
| FaxNumber: | 7085240300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2009 | ||||||||
| LastUpdateDate: | 04/25/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.