Individual
JAKE FUNDERBURK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1243 S 74TH EAST AVE, TULSA, OK 74112-6717
(318) 423-5431
Mailing address
1243 S 74TH EAST AVE, TULSA, OK 74112-6717
(318) 423-5431
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
L083484046
OK
Other
Enumeration date
06/03/2024
Last updated
06/03/2024
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