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General NPI Number Information
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NPI Number | 1134576341
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Entity Type | Individual
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Provider Name | JAITHRA JAYAKRISHNAN
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Gender | Female
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Dates
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Enumeration Date | 05/17/2016
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 4301 RISING SUN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19140-2719
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Country | US
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Telephone | 267-296-7231
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Fax | 267-332-5175
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Provider Business Mailing Address
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Address Line | 4301 RISING SUN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19140-2719
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Country | US
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Telephone | 347-777-7353
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Fax | 267-332-5175
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00829300
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC009108
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License Number State | PA
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