Provider Demographics
NPI:1679852750
Name:FUNKHOUSER, SCARLETT DIANA
Entity type:Individual
Prefix:
First Name:SCARLETT
Middle Name:DIANA
Last Name:FUNKHOUSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7307
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-7307
Mailing Address - Country:US
Mailing Address - Phone:253-400-6723
Mailing Address - Fax:
Practice Address - Street 1:21137 STATE ROUTE 410 E STE A
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-8775
Practice Address - Country:US
Practice Address - Phone:253-400-6723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor