Provider Demographics
NPI:1649521840
Name:LAJEUNESSE, MARY E (LPE)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:LAJEUNESSE
Suffix:
Gender:F
Credentials:LPE
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2850 PRINCE ST STE 53
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3600
Mailing Address - Country:US
Mailing Address - Phone:501-764-3002
Mailing Address - Fax:
Practice Address - Street 1:2850 PRINCE ST STE 53
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3600
Practice Address - Country:US
Practice Address - Phone:501-764-3002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR11-46AE PL101YM0800X
AR13-10EI103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health