Provider Demographics
NPI:1790900835
Name:GOMPERT-FUNK, REBECCA (LPC-MH)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GOMPERT-FUNK
Suffix:
Gender:F
Credentials:LPC-MH
Other - Prefix:
Other - First Name:REBECKA
Other - Middle Name:KAY
Other - Last Name:GOMPERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3303 ROUGHLOCK LN
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-9592
Mailing Address - Country:US
Mailing Address - Phone:605-645-0141
Mailing Address - Fax:
Practice Address - Street 1:3303 ROUGHLOCK LN
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-9592
Practice Address - Country:US
Practice Address - Phone:605-645-0141
Practice Address - Fax:605-645-0141
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC951101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4995828OtherBLUE CROSS/BLUE SHIELD