Provider Demographics
NPI:1588683643
Name:FUNKE, VERONICA MENA (LCSW)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:MENA
Last Name:FUNKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 FM 1960 RD W STE 580
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-4652
Mailing Address - Country:US
Mailing Address - Phone:346-331-0321
Mailing Address - Fax:281-466-4880
Practice Address - Street 1:4606 FM 1960 RD W STE 580
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4652
Practice Address - Country:US
Practice Address - Phone:346-331-0321
Practice Address - Fax:281-466-4880
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32342104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177971201Medicaid