1578035325 NPI number — JITHIN VIJAYAN MA, LPCC

Table of content: JITHIN VIJAYAN MA, LPCC (NPI 1578035325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578035325 NPI number — JITHIN VIJAYAN MA, LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VIJAYAN
Provider First Name:
JITHIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LPCC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578035325
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
204 LOOKOUT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45419-3812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-443-7019
Provider Business Mailing Address Fax Number:
937-353-9386

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 LOOKOUT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45419-3812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-443-7019
Provider Business Practice Location Address Fax Number:
937-353-9386
Provider Enumeration Date:
12/18/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  068.0134892TELE , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: E.2404286 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: E.2404286 . This is a "OHIO COUNSELOR, SOCIAL WORKER, AND MARRIAGE AND FAMILY THERAPIST BOARD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P2303011 . This is a "ARKANSAS BOARD OF EXAMINERS IN COUNSELING AND MARRIAGE AND FAMILY THERAPY" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: PC010866 . This is a "PENNSYLVANIA STATE BOARD OF SOCIAL WORKERS, MFTS AND PROFESSIONAL COUNSELORS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 068.0134892TELE . This is a "VERMONT OFFICE OF PROFESSIONAL REGULATION" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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