Individual provider · Type 1 NPI

Jacob Wade Funderburk, PLPC

Professional Counselor · Shreveport, LA

NPI number 1639749617 Active

Practice location

6240 Greenwood Rd
Shreveport, LA 71119-8413

Call (318) 562-6320 Map

Mailing address

652 Prospect St
Shreveport, LA 71104-3124

Other practice locations

  • 2984 Old Plain Dealing Rd, Plain Dealing, LA 71064-4320 · (318) 508-1301

Specialties and licenses

TaxonomyCodeLicense
Professional Counselor Primary 101YP2500X8671 (LA)

Professional Counselor: Definition to come...

15 other providers at this address

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About NPI 1639749617

Jacob Wade Funderburk, PLPC's National Provider Identifier is 1639749617, issued on Jun 30, 2021. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Shreveport, LA. The record was last updated on Nov 6, 2024.