Provider Demographics
NPI:1215509096
Name:LUBOSKI, JASON (LPC, ATR)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:LUBOSKI
Suffix:
Gender:M
Credentials:LPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:8500 STATION ST STE 112
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4962
Practice Address - Country:US
Practice Address - Phone:440-534-1507
Practice Address - Fax:440-549-0935
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2103538101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health