Provider Demographics
NPI:1528402740
Name:MUNZ, JACOB L (LSW, LCDC III)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:L
Last Name:MUNZ
Suffix:
Gender:M
Credentials:LSW, LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WHITNEY DRIVE SUITE 122
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-8400
Mailing Address - Country:US
Mailing Address - Phone:513-753-9964
Mailing Address - Fax:513-753-9968
Practice Address - Street 1:25 WHITNEY DRIVE SUITE 122
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-8400
Practice Address - Country:US
Practice Address - Phone:513-753-9964
Practice Address - Fax:513-753-9968
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1201584104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker