MEDICARE: ANGELA FUNKE LMFT-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	201661	TX

General Provider Information

NPI Number	:	1417368291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA FUNKE LMFT-S

Provider Business Mailing Address
First Line	:	713 SHERATON AVE
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-2043
Country	:	US
Telephone Number	:	512-466-2239
Fax Number	:

Provider Business Practice Location Address
First Line	:	1907 N LAMAR BLVD
Second Line	:	SUITE 352
City	:	AUSTIN
State	:	TX
Zip	:	78705-4992
Country	:	US
Telephone Number	:	512-466-2239
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2014
Last Update Date	:	03/29/2017

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