Individual
JACOB WADE FUNDERBURK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PLPC
Contact information
Practice address
6240 GREENWOOD RD, SHREVEPORT, LA 71119-8413
(318) 562-6320
Mailing address
652 PROSPECT ST, SHREVEPORT, LA 71104-3124
(318) 508-1301
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
8671
LA
Other
Enumeration date
06/30/2021
Last updated
11/06/2024
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