Healthcare Provider Details

I. General information

NPI: 1396608204
Provider Name (Legal Business Name): JAYBIRD BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N MAIN ST UNIT 874453
WASILLA AK
99687-1629
US

IV. Provider business mailing address

401 N MAIN ST UNIT 874453
WASILLA AK
99687-1629
US

V. Phone/Fax

Practice location:
  • Phone: 304-208-5726
  • Fax:
Mailing address:
  • Phone: 304-208-5726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LESLIE LAJEUNESSE
Title or Position: OWNER
Credential: APRN, PMHNP-BC
Phone: 304-208-5726