Healthcare Provider Details

I. General information

NPI: 1396331385
Provider Name (Legal Business Name): GLEN ROBERT AITKEN JR. MS, LMHC, MCAP, CCTP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 W INDIANTOWN RD
JUPITER FL
33458-4628
US

IV. Provider business mailing address

1216 NEOGA ST
JUPITER FL
33458-5662
US

V. Phone/Fax

Practice location:
  • Phone: 561-252-1325
  • Fax:
Mailing address:
  • Phone: 561-252-1325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH18449
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: