Provider Demographics
NPI:1649265521
Name:FUNT, DOUGLAS E (PHD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:E
Last Name:FUNT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 E ARAPAHOE RD
Mailing Address - Street 2:STE 260
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1266
Mailing Address - Country:US
Mailing Address - Phone:303-337-0710
Mailing Address - Fax:303-796-7115
Practice Address - Street 1:7700 E ARAPAHOE RD
Practice Address - Street 2:STE 260
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1266
Practice Address - Country:US
Practice Address - Phone:303-337-0710
Practice Address - Fax:303-796-7115
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO699103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07107873Medicaid
COC96006Medicare PIN