Individual
JAYKANO COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICDC, LPC
Contact information
Practice address
700 PARK AVE, IRONTON, OH 45638-1502
(740) 532-1613
(740) 532-1715
Mailing address
PO BOX 108, IRONTON, OH 45638-0108
(740) 532-1613
(740) 532-1715
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LICDC.162775
OH
101YP2500X
Professional Counselor
C.2506755
OH
171M00000X
Case Manager/Care Coordinator
CDCA.172087
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0323103
—
OH
Enumeration date
09/13/2018
Last updated
02/24/2025
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