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General NPI Number Information
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NPI Number | 1578035325
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Entity Type | Individual
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Provider Name | JITHIN VIJAYAN MA, LPCC
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Gender | Male
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Dates
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Enumeration Date | 12/18/2018
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Last Update Date | 06/30/2024
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Provider Practice Location Address
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Address Line | 204 LOOKOUT DR
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City | OAKWOOD
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State | OH
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Zip | 45419-3812
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Country | US
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Telephone | 937-443-7019
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Fax | 937-353-9386
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Provider Business Mailing Address
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Address Line | 204 LOOKOUT DR
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City | OAKWOOD
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State | OH
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Zip | 45419-3812
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Country | US
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Telephone | 937-443-7019
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Fax | 937-353-9386
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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 | 068.0134892TELE
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License Number State | VT
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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 | E.2404286
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License Number State | OH
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