Provider Demographics
NPI:1033514062
Name:FUNK, AUDRA JOY (LPC)
Entity type:Individual
Prefix:MS
First Name:AUDRA
Middle Name:JOY
Last Name:FUNK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:AUDRA
Other - Middle Name:JOY
Other - Last Name:INGRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:101 S. FANNIN ST.
Mailing Address - Street 2:STE 112
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087
Mailing Address - Country:US
Mailing Address - Phone:469-391-0210
Mailing Address - Fax:469-391-0210
Practice Address - Street 1:500 TURTLE COVE
Practice Address - Street 2:SUITE 200 A
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087
Practice Address - Country:US
Practice Address - Phone:972-743-1080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69473101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty