Basic Information
| Provider Information | |||||||||
| NPI: | 1487981551 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUNN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | LEROY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 N MAIN ST | ||||||||
| Address2: | P.O. BOX 683 | ||||||||
| City: | NILES | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444465003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305445005 | ||||||||
| FaxNumber: | 3305449379 | ||||||||
| Practice Location | |||||||||
| Address1: | 43 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NILES | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444465003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305445005 | ||||||||
| FaxNumber: | 3305449379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2009 | ||||||||
| LastUpdateDate: | 11/19/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | C0800414 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.