Healthcare Provider Details

I. General information

NPI: 1417617812
Provider Name (Legal Business Name): LAJEAN'S MENTAL HEALTH BOUTIQUE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 05/30/2023
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3094 W MARKET ST STE 190
FAIRLAWN OH
44333-3626
US

IV. Provider business mailing address

575 WOODVIEW DR
AKRON OH
44319-1343
US

V. Phone/Fax

Practice location:
  • Phone: 133-090-7155
  • Fax:
Mailing address:
  • Phone: 330-907-1556
  • Fax: 845-859-8649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DEWAN SMITH-MURRAY
Title or Position: CEO
Credential: APRN CNP
Phone: 330-595-9929