Provider Demographics
NPI:1164153748
Name:FUNK, MALLORY (MSW)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:FUNK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 N MCCOLL RD APT 3101
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4483
Mailing Address - Country:US
Mailing Address - Phone:801-710-9988
Mailing Address - Fax:
Practice Address - Street 1:1109 E SAM HOUSTON BLVD
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5629
Practice Address - Country:US
Practice Address - Phone:801-710-9988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105024104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker