Provider Demographics
NPI:1730794298
Name:CHRISTIAN, JIMMY JAY (LCDCII)
Entity type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:JAY
Last Name:CHRISTIAN
Suffix:
Gender:M
Credentials:LCDCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 N LEVITT RD
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035
Mailing Address - Country:US
Mailing Address - Phone:440-328-4213
Mailing Address - Fax:
Practice Address - Street 1:530 N LEVITT RD
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035
Practice Address - Country:US
Practice Address - Phone:440-284-2133
Practice Address - Fax:440-328-4214
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.170623101YA0400X
OHCDCA.173950101YA0400X
OHLCDCII.161739101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)