Healthcare Provider Details

I. General information

NPI: 1295008415
Provider Name (Legal Business Name): JESSICA COURTNEY FUNK LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2012
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24020 ORLEANS LN
MURRIETA CA
92562-1937
US

IV. Provider business mailing address

24020 ORLEANS LN
MURRIETA CA
92562-1937
US

V. Phone/Fax

Practice location:
  • Phone: 909-273-8127
  • Fax:
Mailing address:
  • Phone: 951-279-3222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number105709
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: