Provider Demographics
NPI:1902473903
Name:MYNCHENBERG, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MYNCHENBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 AVONDALE DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-7750
Mailing Address - Country:US
Mailing Address - Phone:216-956-6250
Mailing Address - Fax:
Practice Address - Street 1:8536 CROW DR STE 240
Practice Address - Street 2:
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-1986
Practice Address - Country:US
Practice Address - Phone:330-888-9596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-21-49254103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst