| Doctor Name: | JASON MUNZKE |
| NPI Number: | 1013162916 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.C.P.C. |
| License Number: | LCPC 3986 |
| Business Practice Address: | 513 N 4th Ave Sandpoint, ID - 838641585 |
| Business Phone Number: | 2082556803 |
| Business Fax Number: | 2082630951 |
| Mailing Address: | 513 N 4th Ave, SANDPOINT |
| State: | ID |
| Postal Code: | 838641585 |
| Phone Number: | 2082556803 |
| Fax Number: | 2082630951 |
| NPI Enumeration Date: | 11/20/2008 |
| NPI Last Update Date: | 11/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LCPC 3986 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |