Provider Demographics
NPI:1053865493
Name:FUNCK, PATRICIA JOAN (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JOAN
Last Name:FUNCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:JOAN
Other - Last Name:FUNCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:7212 JOLIET AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1123
Mailing Address - Country:US
Mailing Address - Phone:806-791-2829
Mailing Address - Fax:806-791-3744
Practice Address - Street 1:7212 JOLIET AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1137
Practice Address - Country:US
Practice Address - Phone:806-791-2829
Practice Address - Fax:806-791-3744
Is Sole Proprietor?:No
Enumeration Date:2016-08-14
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical