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General NPI Number Information
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NPI Number | 1750354890
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Entity Type | Organization
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Legal Business Name | DONALD L MUNN
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 09/03/2008
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Provider Practice Location Address
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Address Line | 106 E BERRY ST
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City | MIDDLEBURY
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State | IN
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Zip | 46540
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Country | US
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Telephone | 574-825-7662
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Fax | 574-825-3254
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Provider Business Mailing Address
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Address Line | PO BOX 63
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City | MIDDLEBURY
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State | IN
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Zip | 46540
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Country | US
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Telephone | 574-825-7662
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Fax | 574-825-3254
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Authorized Official
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Title or Position | OWNER
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Name | MR. DONALD L MUNN
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Credential | MSW ACSW LCSW LMFT
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Telephone | 574-825-7662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 35001177A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34000437A
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License Number State | IN
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