Provider Demographics
NPI:1578035325
Name:VIJAYAN, JITHIN (MA, LPCC)
Entity type:Individual
Prefix:
First Name:JITHIN
Middle Name:
Last Name:VIJAYAN
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 LOOKOUT DR
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45419-3812
Mailing Address - Country:US
Mailing Address - Phone:937-443-7019
Mailing Address - Fax:937-353-9386
Practice Address - Street 1:204 LOOKOUT DR
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:OH
Practice Address - Zip Code:45419-3812
Practice Address - Country:US
Practice Address - Phone:937-443-7019
Practice Address - Fax:937-353-9386
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2024-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134892TELE101YM0800X
OHE.2404286101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE.2404286OtherOHIO COUNSELOR, SOCIAL WORKER, AND MARRIAGE AND FAMILY THERAPIST BOARD
ARP2303011OtherARKANSAS BOARD OF EXAMINERS IN COUNSELING AND MARRIAGE AND FAMILY THERAPY
PAPC010866OtherPENNSYLVANIA STATE BOARD OF SOCIAL WORKERS, MFTS AND PROFESSIONAL COUNSELORS
VT068.0134892TELEOtherVERMONT OFFICE OF PROFESSIONAL REGULATION