Provider Demographics
NPI:1013162916
Name:MUNZKE, JASON (LCPC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MUNZKE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1585
Mailing Address - Country:US
Mailing Address - Phone:208-255-6803
Mailing Address - Fax:208-263-0951
Practice Address - Street 1:513 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1585
Practice Address - Country:US
Practice Address - Phone:208-255-6803
Practice Address - Fax:208-263-0951
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC 3986101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health