Provider Demographics
NPI:1902885163
Name:JUNG, AUDREY BETH (LPC, NCC, FAPA)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:BETH
Last Name:JUNG
Suffix:
Gender:F
Credentials:LPC, NCC, FAPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 S KYRENE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-4687
Mailing Address - Country:US
Mailing Address - Phone:480-775-6423
Mailing Address - Fax:480-775-6425
Practice Address - Street 1:90 S KYRENE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-4687
Practice Address - Country:US
Practice Address - Phone:480-775-6423
Practice Address - Fax:480-775-6425
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-15
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC1691101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1861892689OtherNPPES