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General NPI Number Information
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NPI Number | 1194582296
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Entity Type | Organization
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Legal Business Name | BLUEJAY COUNSELING & ART THERAPY LLC
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Dates
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Enumeration Date | 03/05/2024
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Last Update Date | 06/01/2025
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Provider Practice Location Address
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Address Line | 8674 MENTOR AVE STE 6
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City | MENTOR
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State | OH
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Zip | 44060-6143
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Country | US
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Telephone | 440-256-6189
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Fax | 440-549-0939
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Provider Business Mailing Address
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Address Line | 5600 DEERBORN AVE
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City | MENTOR
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State | OH
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Zip | 44060-2008
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Country | US
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Telephone | 440-390-8692
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER
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Name | JASON LUBOSKI
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Credential | LPCC, ATR-BC
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Telephone | 440-390-8692
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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