Provider Demographics
NPI:1659556082
Name:FUNKHOUSER, LAURA JEAN
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JEAN
Last Name:FUNKHOUSER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:JEAN
Other - Last Name:LUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2491 CARMICHAEL DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7190
Mailing Address - Country:US
Mailing Address - Phone:530-898-6525
Mailing Address - Fax:530-898-4780
Practice Address - Street 1:2491 CARMICHAEL DR
Practice Address - Street 2:SUITE 400
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-7190
Practice Address - Country:US
Practice Address - Phone:530-898-6525
Practice Address - Fax:530-898-4780
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker