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General NPI Number Information
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NPI Number | 1285953539
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Entity Type | Individual
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Provider Name | BRYAN ANDREW FUNK MA
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Gender | Male
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Dates
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Enumeration Date | 05/26/2010
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Last Update Date | 05/26/2010
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Provider Practice Location Address
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Address Line | 901 EASTERN AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49501-0294
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Country | US
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Telephone | 616-224-7578
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Fax | 616-224-7581
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Provider Business Mailing Address
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Address Line | 901 EASTERN AVE NE P.O. BOX 294
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City | GRAND RAPIDS
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State | MI
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Zip | 49501-0294
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Country | US
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Telephone | 616-224-7578
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Fax | 616-224-7581
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39000678A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401010973
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License Number State | MI
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