Individual provider Active NPI

Jaykano Cooper, LICDC, LPC

  • Addiction (Substance Use Disorder) Counselor
  • Ironton, OH
National Provider Identifier
1447733514
Registry record updated Feb 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
LICDC.162775 Issued in OH
Practice address
700 Park Ave
Ironton, OH 45638-1502
Phone
(740) 532-1613
Fax
(740) 532-1715
NPI assigned
Sep 13, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X C.2506755 OH
Case Manager/Care Coordinator 171M00000X CDCA.172087 OH
Addiction (Substance Use Disorder) Counselor 101YA0400X LICDC.162775 OH Primary

Addresses

Primary practice location

700 Park Ave
Ironton, OH 45638-1502

Mailing address

PO Box 108
Ironton, OH 45638-0108
Phone (740) 532-1613

Other identifiers 1

IdentifierTypeStateIssuer
0323103MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250221001153 OH Practitioner - Mental Health Counselor 8729508676 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mended Reeds Services IncGroup PAC ID 5092013987, 13 clinicians

Practice addresses (Care Compare)

700 Park Ave
Ironton, OH 45638-1502
Phone (740) 532-6220

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LICDC.162775OHMDAddiction (Substance Use Disorder) Counselor
C.2506755OHMDProfessional Counselor
CDCA.172087OHMDCase Manager/Care Coordinator

Practice roles

OrganizationSpecialtyStatusNew patients
Mended Reeds Services, Inc. Professional CurrentSince Feb 5, 2025 Accepting new patients

Locations

700 Park Ave
Ironton, OH 45638
Phone (740) 532-1613

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1536796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740355200000",
    "number": "1447733514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 108",
            "city": "IRONTON",
            "state": "OH",
            "postal_code": "456380108",
            "telephone_number": "740-532-1613",
            "fax_number": "740-532-1715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 PARK AVE",
            "city": "IRONTON",
            "state": "OH",
            "postal_code": "456381502",
            "telephone_number": "740-532-1613",
            "fax_number": "740-532-1715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "JAYKANO",
        "credential": "LICDC, LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-13",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "C.2506755",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "OH",
            "license": "CDCA.172087",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "LICDC.162775",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0323103",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ironton, OH

Sources for this page

Verify at the official NPI Registry.