Provider Demographics
NPI:1912288143
Name:FUNCHEON, ROBERT J (LSCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:FUNCHEON
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 FLAGSTAFF ST
Mailing Address - Street 2:
Mailing Address - City:BEL AIRE
Mailing Address - State:KS
Mailing Address - Zip Code:67220-1863
Mailing Address - Country:US
Mailing Address - Phone:316-841-3760
Mailing Address - Fax:
Practice Address - Street 1:1855 N WEBB RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3413
Practice Address - Country:US
Practice Address - Phone:376-636-2888
Practice Address - Fax:316-636-2666
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45011041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical