Active NPI
Bryan Andrew Funk, MA
- Professional Counselor
- Grand Rapids, MI
National Provider Identifier
1285953539
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401010973
- Practice address
- 901 Eastern Ave NE
Grand Rapids, MI 49501-0294 - Phone
- (616) 224-7578
- Fax
- (616) 224-7581
- NPI assigned
- May 26, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 39000678A | IN | |
| Professional Counselor | 101YP2500X | 6401010973 | MI | Primary |
Addresses
Primary practice location
901 Eastern Ave NE
Grand Rapids, MI 49501-0294
Mailing address
901 Eastern Ave NE
P.O. Box 294
Grand Rapids, MI 49501-0294
Phone (616) 224-7578
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39000678A | IN | MD | Mental Health Counselor |
| 6401010973 | MI | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bethany Christian Services Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Grand Rapids, MI
- NPI 1528104643
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1274832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274832000000",
"number": "1285953539",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "901 EASTERN AVE NE",
"address_2": "P.O. BOX 294",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495010294",
"telephone_number": "616-224-7578",
"fax_number": "616-224-7581"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 EASTERN AVE NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495010294",
"telephone_number": "616-224-7578",
"fax_number": "616-224-7581"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUNK",
"first_name": "BRYAN",
"middle_name": "ANDREW",
"name_prefix": "Mr.",
"credential": "MA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-05-26",
"last_updated": "2010-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IN",
"license": "39000678A",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401010973",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.