Provider Demographics
NPI:1982625208
Name:VUKASINOVICH, KEITH ANTHONY (LPCC)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:ANTHONY
Last Name:VUKASINOVICH
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 LINDEN AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45437
Mailing Address - Country:US
Mailing Address - Phone:937-254-7301
Mailing Address - Fax:937-254-2117
Practice Address - Street 1:4130 LINDEN AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45437
Practice Address - Country:US
Practice Address - Phone:937-254-7301
Practice Address - Fax:937-254-2117
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 3246101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH310734113OtherUBH
OH310734113OtherTAX I.D.
OHMC0713Medicaid