Provider Demographics
NPI:1205422342
Name:LAJEAN'S MENTAL HEALTH BOUTIQUE, LLC
Entity type:Organization
Organization Name:LAJEAN'S MENTAL HEALTH BOUTIQUE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHMAPRN-CNP-BC
Authorized Official - Phone:330-907-1556
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:330-907-1556
Mailing Address - Fax:213-203-1335
Practice Address - Street 1:10 COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
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?:Yes
Parent Organization LBN:LAJEANS MENTAL HEALTH BOUTIQUE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-14
Last Update Date:2021-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty