Provider Demographics
NPI:1821858986
Name:BJL2, INC
Entity Type:Organization
Organization Name:BJL2, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LICHTENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-697-5943
Mailing Address - Street 1:1910 W PICKETT CT
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442-3244
Mailing Address - Country:US
Mailing Address - Phone:352-697-5942
Mailing Address - Fax:
Practice Address - Street 1:1910 W PICKETT CT
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:FL
Practice Address - Zip Code:34442-3244
Practice Address - Country:US
Practice Address - Phone:352-697-5942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty