Provider Demographics
NPI:1093347718
Name:LAJEAN'S MENTAL HEALTH BOUTIQUE, LLC
Entity Type:Organization
Organization Name:LAJEAN'S MENTAL HEALTH BOUTIQUE, LLC
Other - Org Name:LAJEANS MENTAL HEALTH REHAB BOUTIQUE LLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:DEWAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:330-595-9929
Mailing Address - Street 1:575 WOODVIEW DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-1343
Mailing Address - Country:US
Mailing Address - Phone:330-858-4725
Mailing Address - Fax:
Practice Address - Street 1:10 COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-2819
Practice Address - Country:US
Practice Address - Phone:330-595-9929
Practice Address - Fax:845-859-8649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2021-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty