Provider Demographics
NPI:1548754146
Name:WAINSCOTT, JAY OWEN (LPCC, LICDC-CS)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:OWEN
Last Name:WAINSCOTT
Suffix:
Gender:M
Credentials:LPCC, LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 COBBLESKILL CT
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2136
Mailing Address - Country:US
Mailing Address - Phone:937-689-6528
Mailing Address - Fax:
Practice Address - Street 1:6239 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-7108
Practice Address - Country:US
Practice Address - Phone:937-319-4448
Practice Address - Fax:937-630-4391
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.111040101YA0400X
OHE.1700023-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)