Provider Demographics
NPI:1194582296
Name:BLUEJAY COUNSELING & ART THERAPY LLC
Entity type:Organization
Organization Name:BLUEJAY COUNSELING & ART THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, ATR-BC
Authorized Official - Phone:440-390-8692
Mailing Address - Street 1:5600 DEERBORN AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-2008
Mailing Address - Country:US
Mailing Address - Phone:440-390-8692
Mailing Address - Fax:
Practice Address - Street 1:8674 MENTOR AVE STE 6
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6143
Practice Address - Country:US
Practice Address - Phone:440-256-6189
Practice Address - Fax:440-549-0939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty