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General NPI Number Information
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NPI Number | 1982625208
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Entity Type | Individual
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Provider Name | KEITH ANTHONY VUKASINOVICH LPCC
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Gender | Male
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 201 W FRANKLIN ST STE B
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City | CENTERVILLE
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State | OH
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Zip | 45459-4700
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Country | US
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Telephone | 937-672-1424
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Fax | 937-971-4529
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Provider Business Mailing Address
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Address Line | 4130 LINDEN AVE SUITE 309
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City | DAYTON
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State | OH
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Zip | 45437
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Country | US
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Telephone | 937-254-7301
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Fax | 937-254-2117
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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 | E 3246
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License Number State | OH
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