Provider Demographics
NPI:1467803445
Name:FUNK, KERI (MS LMHC, RPT)
Entity Type:Individual
Prefix:MRS
First Name:KERI
Middle Name:
Last Name:FUNK
Suffix:
Gender:F
Credentials:MS LMHC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8677 PINTER ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7501
Mailing Address - Country:US
Mailing Address - Phone:407-782-8827
Mailing Address - Fax:
Practice Address - Street 1:8677 PINTER ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7501
Practice Address - Country:US
Practice Address - Phone:407-782-8827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13459101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health