Provider Demographics
NPI:1174319693
Name:STUCKEY, JANJAI MARITONEA (LIFE COACH, QMHS)
Entity type:Individual
Prefix:MRS
First Name:JANJAI
Middle Name:MARITONEA
Last Name:STUCKEY
Suffix:
Gender:
Credentials:LIFE COACH, QMHS
Other - Prefix:MS
Other - First Name:JANJAI
Other - Middle Name:MARITONEA
Other - Last Name:LIPSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2323 LAKE CLUB DR STE 118
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-3198
Mailing Address - Country:US
Mailing Address - Phone:614-266-2004
Mailing Address - Fax:
Practice Address - Street 1:2323 LAKE CLUB DR STE 118
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-3198
Practice Address - Country:US
Practice Address - Phone:614-266-2004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker