Provider Demographics
NPI:1205038239
Name:FUNK, ELIZABETH (PLMHP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:FUNK
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 S 87TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3042
Mailing Address - Country:US
Mailing Address - Phone:402-250-7995
Mailing Address - Fax:
Practice Address - Street 1:3031 S 87TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3042
Practice Address - Country:US
Practice Address - Phone:402-250-7995
Practice Address - Fax:402-763-4492
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7642101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health