Active NPI
Theresa Funk, LBSW
- Social Worker
- Grand Rapids, MI
National Provider Identifier
1619368552
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6802062779
- Practice address
- 4255 Kalamazoo Ave SE
Grand Rapids, MI 49508-3638 - Phone
- (616) 455-0960
- NPI assigned
- Feb 13, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 6802062779 | MI | Primary |
Addresses
Primary practice location
4255 Kalamazoo Ave SE
Grand Rapids, MI 49508-3638
Mailing address
PO Box 68327
Grand Rapids, MI 49516-8327
Phone (616) 774-0538
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6802062779 | MI | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thresholds Inc | Past | Accepting new patients | |
| Kent County CMH Authority | Past | Accepting new patients |
Organizations & group practices 2
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 1194617811
-
- Case Management Agency
- Grand Rapids, MI
- NPI 1154403467
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1423785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423785600000",
"number": "1619368552",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 68327",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495168327",
"telephone_number": "616-774-0538"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4255 KALAMAZOO AVE SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495083638",
"telephone_number": "616-455-0960"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUNK",
"first_name": "THERESA",
"credential": "LBSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-02-13",
"last_updated": "2015-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6802062779",
"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 Feb 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.