Provider Demographics
NPI:1114390234
Name:MUNLEY, J THOMAS (LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:J
Middle Name:THOMAS
Last Name:MUNLEY
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9724 LAKEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:PERRINTON
Mailing Address - State:MI
Mailing Address - Zip Code:48871-8600
Mailing Address - Country:US
Mailing Address - Phone:517-706-7311
Mailing Address - Fax:
Practice Address - Street 1:168 E CENTER ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:MI
Practice Address - Zip Code:48847-1436
Practice Address - Country:US
Practice Address - Phone:989-875-0284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-11
Last Update Date:2015-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012859101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI13653731OtherCAQH