Provider Demographics
NPI:1679668545
Name:FUNK, EUGENIA FOY (PHD)
Entity Type:Individual
Prefix:DR
First Name:EUGENIA
Middle Name:FOY
Last Name:FUNK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:EUGENIA
Other - Middle Name:
Other - Last Name:BELLANTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD CLINICAL PSYCH
Mailing Address - Street 1:3400 WAGONWHEEL RD.
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8024
Mailing Address - Country:US
Mailing Address - Phone:406-587-9300
Mailing Address - Fax:406-587-9300
Practice Address - Street 1:3400 WAGONWHEEL RD.
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8024
Practice Address - Country:US
Practice Address - Phone:406-587-9300
Practice Address - Fax:406-587-9300
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT279103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT493428Medicaid
MT5450Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST