MEDICARE: BRIGETTE FUNK LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701006342	VA

General Provider Information

NPI Number	:	1467811943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIGETTE FUNK LPC

Provider Business Mailing Address
First Line	:	3959 ELECTRIC RD STE 345
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-4509
Country	:	US
Telephone Number	:	540-904-6032
Fax Number	:	540-904-6064

Provider Business Practice Location Address
First Line	:	3959 ELECTRIC RD STE 345
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-4509
Country	:	US
Telephone Number	:	540-904-6032
Fax Number	:	540-904-6064

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2016
Last Update Date	:	02/12/2016

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