Healthcare Provider Details

I. General information

NPI: 1659259950
Provider Name (Legal Business Name): LJT THERAPEUTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5113 S HARPER AVE STE 2C
CHICAGO IL
60615-4119
US

IV. Provider business mailing address

5322 S HUNT AVE
SUMMIT IL
60501-1024
US

V. Phone/Fax

Practice location:
  • Phone: 708-332-1782
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAHAJI THOMAS
Title or Position: CEO
Credential: LCSW
Phone: 773-600-6667