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General NPI Number Information
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NPI Number | 1699147793
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Entity Type | Organization
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Legal Business Name | SUNRISE PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 10/28/2015
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Last Update Date | 03/24/2016
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Provider Practice Location Address
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Address Line | 6601 CYPRESSWOOD DR 201
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City | SPRING
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State | TX
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Zip | 77379-7891
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Country | US
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Telephone | 281-203-1843
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Fax |
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Provider Business Mailing Address
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Address Line | 6601 CYPRESSWOOD DR 201
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City | SPRING
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State | TX
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Zip | 77379-7891
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Country | US
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Telephone | 281-203-1843
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VERONICA MENA FUNKE
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Credential | LCSW
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Telephone | 281-203-1843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 32342
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License Number State | TX
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