Healthcare Provider Details

I. General information

NPI: 1063349744
Provider Name (Legal Business Name): NICHOLAS MUNK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E GRANGER RD
INDEPENDENCE OH
44131-6704
US

IV. Provider business mailing address

402 E 307TH ST
WILLOWICK OH
44095-3726
US

V. Phone/Fax

Practice location:
  • Phone: 888-586-7186
  • Fax:
Mailing address:
  • Phone: 440-283-9361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRS.007759
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: