Provider Demographics
NPI:1376228189
Name:FUNK, RONELLE (LMHCA)
Entity Type:Individual
Prefix:
First Name:RONELLE
Middle Name:
Last Name:FUNK
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 CUSTER WAY SW STE 204
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-3330
Mailing Address - Country:US
Mailing Address - Phone:360-469-0301
Mailing Address - Fax:
Practice Address - Street 1:204 CUSTER WAY SW STE 204
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-3330
Practice Address - Country:US
Practice Address - Phone:360-469-0301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60972357101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health