Provider Demographics
NPI:1013553411
Name:FUNK, CARL (LPC)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:
Last Name:FUNK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 WELLS BRANCH PKWY APT 624
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-6789
Mailing Address - Country:US
Mailing Address - Phone:512-596-7500
Mailing Address - Fax:
Practice Address - Street 1:600 W 28TH ST STE 207
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3798
Practice Address - Country:US
Practice Address - Phone:512-596-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74681101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty