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General NPI Number Information
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NPI Number | 1700021300
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Entity Type | Organization
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Legal Business Name | LJ BEHAVIORAL HEALTH COUNSELING LLC
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Dates
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Enumeration Date | 12/10/2008
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 224 FARMSTEAD RD
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City | SOUTHINGTON
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State | CT
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Zip | 06489-2462
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Country | US
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Telephone | 860-324-6289
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Fax |
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Provider Business Mailing Address
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Address Line | 224 FARMSTEAD RD
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City | SOUTHINGTON
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State | CT
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Zip | 06489-2462
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Country | US
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Telephone | 860-324-6289
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAURA JAKABAUSKI
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Credential |
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Telephone | 860-324-6289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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