Healthcare Provider Details

I. General information

NPI: 1821858986
Provider Name (Legal Business Name): BJL2, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 W PICKETT CT
HERNANDO FL
34442-3244
US

IV. Provider business mailing address

1910 W PICKETT CT
HERNANDO FL
34442-3244
US

V. Phone/Fax

Practice location:
  • Phone: 352-697-5942
  • Fax:
Mailing address:
  • Phone: 352-697-5942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JEAN MARIE LICHTENTHAL
Title or Position: MANAGER
Credential:
Phone: 352-697-5943