Provider Demographics
NPI:1912164831
Name:FUNK WELZENBACH, HILLARY SWAN (LCPC)
Entity type:Individual
Prefix:MS
First Name:HILLARY
Middle Name:SWAN
Last Name:FUNK WELZENBACH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4929
Mailing Address - Country:US
Mailing Address - Phone:406-728-2662
Mailing Address - Fax:406-728-2879
Practice Address - Street 1:2237 S 3RD ST W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-1334
Practice Address - Country:US
Practice Address - Phone:406-541-2662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1360101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional