Healthcare Provider Details

I. General information

NPI: 1831613751
Provider Name (Legal Business Name): JAMI MUNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 GRANDVIEW AVE
PORTSMOUTH OH
45662-3018
US

IV. Provider business mailing address

2141 GRANDVIEW AVE
PORTSMOUTH OH
45662-3018
US

V. Phone/Fax

Practice location:
  • Phone: 740-646-4464
  • Fax:
Mailing address:
  • Phone: 740-646-4464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number161562
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.1500212
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1901025
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberC.1500212
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: