Provider Demographics
NPI:1962034017
Name:FUNK, RYAN THOMAS (LMSW, LMAC)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:THOMAS
Last Name:FUNK
Suffix:
Gender:M
Credentials:LMSW, LMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W 31ST ST STE G
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-3051
Mailing Address - Country:US
Mailing Address - Phone:913-747-5087
Mailing Address - Fax:
Practice Address - Street 1:2500 W 31ST ST STE G
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-3051
Practice Address - Country:US
Practice Address - Phone:913-747-5087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS128711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201258150AMedicaid