Funkhouser, Gerry Wade

Funkhouser, Gerry Wade is an individual health care provider with primary practice located at 103 W 10Th St , Rolla MO 65401. He recently has only one registered license in Behavioral Health & Social Service Providers / Counselor, which is considered as his primary health care specialty. Funkhouser, Gerry Wade can be contacted via phone (833) 338-4673.

Contact Information

Primary practice address
103 W 10Th St Rolla MO 65401
Phone: (833) 338-4673
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X 2017034374 Missouri

Profile Details

NPI number 1427567726
LBN Legal business name Funkhouser, Gerry Wade
Credentials PLPC
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 29th, 2017
Last updated Mar 6th, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1427567726 NPPES
Missouri MEDICAID 1427567726

Popular Providers