Provider Demographics
NPI:1417368291
Name:FUNKE, ANGELA (LMFT-S)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:FUNKE
Suffix:
Gender:F
Credentials:LMFT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 SHERATON AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-2043
Mailing Address - Country:US
Mailing Address - Phone:512-466-2239
Mailing Address - Fax:
Practice Address - Street 1:1907 N LAMAR BLVD
Practice Address - Street 2:SUITE 352
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-4992
Practice Address - Country:US
Practice Address - Phone:512-466-2239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201661106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist