MEDICARE: DONALD L MUNN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	35001177A	IN
2	1041C0700X	Clinical Social Worker	34000437A	IN

General Provider Information

NPI Number	:	1750354890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONALD L MUNN

Provider Business Mailing Address
First Line	:	PO BOX 63
Second Line	:
City	:	MIDDLEBURY
State	:	IN
Zip	:	46540
Country	:	US
Telephone Number	:	574-825-7662
Fax Number	:	574-825-3254

Provider Business Practice Location Address
First Line	:	106 E BERRY ST
Second Line	:
City	:	MIDDLEBURY
State	:	IN
Zip	:	46540
Country	:	US
Telephone Number	:	574-825-7662
Fax Number	:	574-825-3254

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DONALD L MUNN
Credential	:	MSW ACSW LCSW LMFT
Telephone Number	:	574-825-7662

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	09/03/2008

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