Healthcare Provider Details

I. General information

NPI: 1700363157
Provider Name (Legal Business Name): DAVID M OHRMUND LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 SAEMANN AVE
SHEBOYGAN WI
53081-2342
US

IV. Provider business mailing address

PO BOX 959
SHEBOYGAN WI
53082-0959
US

V. Phone/Fax

Practice location:
  • Phone: 920-783-6633
  • Fax: 920-783-6392
Mailing address:
  • Phone: 920-783-6633
  • Fax: 920-783-6392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4866-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: