Healthcare Provider Details

I. General information

NPI: 1962182121
Provider Name (Legal Business Name): JEEVA COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 06/30/2024
Certification Date: 06/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 LOOKOUT DR
OAKWOOD OH
45419-3812
US

IV. Provider business mailing address

204 LOOKOUT DR
OAKWOOD OH
45419-3812
US

V. Phone/Fax

Practice location:
  • Phone: 937-443-7019
  • Fax: 937-353-9386
Mailing address:
  • Phone: 937-443-7019
  • Fax: 937-353-9386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JITHIN VIJAYAN
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: MA, LPCC
Phone: 937-443-7019