Provider Demographics
NPI:1487981551
Name:MUNN, DAVID LEROY JR (LPC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEROY
Last Name:MUNN
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 N MAIN ST
Mailing Address - Street 2:P.O. BOX 683
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-5003
Mailing Address - Country:US
Mailing Address - Phone:330-544-5005
Mailing Address - Fax:330-544-9379
Practice Address - Street 1:43 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-5003
Practice Address - Country:US
Practice Address - Phone:330-544-5005
Practice Address - Fax:330-544-9379
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0800414101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health