Provider Demographics
NPI:1679049621
Name:JUAREZ, AMBER RAE (QBHS)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:RAE
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:QBHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CHAUTAUQUA AVE
Mailing Address - Street 2:
Mailing Address - City:PEEBLES
Mailing Address - State:OH
Mailing Address - Zip Code:45660-1117
Mailing Address - Country:US
Mailing Address - Phone:937-205-4282
Mailing Address - Fax:
Practice Address - Street 1:313 CHILLICOTHE AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-7378
Practice Address - Country:US
Practice Address - Phone:937-393-9720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2846684Medicaid