Healthcare Provider Details

I. General information

NPI: 1922920016
Provider Name (Legal Business Name): JONATHON DOUGLAS MUMBY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAMIE DELILAH TOROK

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4870 W CLARK RD STE 1
YPSILANTI MI
48197-1104
US

IV. Provider business mailing address

1500 S DOUGLAS RD STE 320
CORAL GABLES FL
33134-4108
US

V. Phone/Fax

Practice location:
  • Phone: 734-361-2504
  • Fax:
Mailing address:
  • Phone: 844-244-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: