Provider Demographics
NPI:1609946144
Name:FUNK, DARICE KATHERINE (MFT)
Entity Type:Individual
Prefix:
First Name:DARICE
Middle Name:KATHERINE
Last Name:FUNK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:DARICE
Other - Middle Name:KATHERINE
Other - Last Name:RICKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:3141 STEVENS CREEK BLVD # 172
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:411 WAINWRIGHT AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2164
Practice Address - Country:US
Practice Address - Phone:408-799-7008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48842106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist