1. Home
  2. Directory
  3. Louisiana
  4. Shreveport
  5. Counselor
  6. NPI Profile

JACOB WADE FUNDERBURK PLPC
NPI 1639749617
Counselor - Professional in Shreveport, LA

Active since June 30, 2021
6240 GREENWOOD RD, SHREVEPORT, LA 71119(318) 562-6320 Get Directions Write a Review

NPPES record last updated: November 6, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Nov 6, 2024, Jun 30, 2021 (2 updates tracked since 2021).

About Jacob Wade Funderburk Plpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACOB WADE FUNDERBURK PLPC (NPI 1639749617) is an individual professional provider in Shreveport, Louisiana, licensed in Louisiana (8671) and active in the NPI registry since June 2021. He maintains a secondary practice location in Plain Dealing.

NPPES Registry Identity

NPI1639749617
Entity TypeIndividualMale
Primary Taxonomy101YP2500X
Provider Legal NameJACOB WADE FUNDERBURKCredential: PLPC
Location Address6240 GREENWOOD RDShreveport, LA 71119-8413
Mailing Address652 Prospect StShreveport, LA 71104-3124 · (318) 508-1301
Phone(318) 562-6320
Sole ProprietorNo
Enumeration DateJune 30, 2021
Last NPPES UpdateNovember 6, 20242 updates tracked since enumeration
NPPES CertifiedNovember 6, 2024
✔ NPI 1639749617 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in LA · 8671
6240 GREENWOOD RD, Shreveport, LA 71119
Open in Google Maps ↗

Secondary Practice Location 1

Location 12984 Old Plain Dealing RdPlain Dealing, LA 71064-4320 · Phone (318) 508-1301

Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LADONNA TERRY WELCH MS, LAC
Counselor (Addiction (Substance Use Disorder))
6240 GREENWOOD RD
SHREVEPORT, LA 71119
Caddo Parish (318) 562-6320
CENTER POINT, INC.
Substance Abuse Rehabilitation Facility
6240 GREENWOOD RD
SHREVEPORT, LA 71119
Caddo Parish (318) 632-2010
JENNIFER LYNN GLEDHILL PLPC
Case Manager/Care Coordinator
6240 GREENWOOD RD
SHREVEPORT, LA 71119
Caddo Parish (318) 562-6320
NEW DAY RECOVERY, LLC
Substance Abuse Rehabilitation Facility
6240 GREENWOOD RD
SHREVEPORT, LA 71119
Caddo Parish (318) 855-8773
CENTER POINT, INC PINES TREATMENT CENTER
Substance Abuse Rehabilitation Facility
6240 GREENWOOD RD
SHREVEPORT, LA 71119
Caddo Parish (318) 632-2010
DEPARTMENT OF HEALTH AND HOSPITALS
Substance Abuse Rehabilitation Facility
6240 GREENWOOD RD
SHREVEPORT, LA 71119
Caddo Parish (318) 632-2010
MYRA CARTER LAC
Counselor (Addiction (Substance Use Disorder))
6240 GREENWOOD RD
SHREVEPORT, LA 71119
Caddo Parish (318) 632-2010
RACHAEL ELIZABETH EDMISTON LMSW
Social Worker
6240 GREENWOOD RD
SHREVEPORT, LA 71119
Caddo Parish (318) 562-6320

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacob Funderburk's NPI number?

The NPI number for Jacob Funderburk is 1639749617. It was assigned to this individual provider in the NPPES registry on June 30, 2021.

Where is Jacob Funderburk located?

Jacob Funderburk practices at 6240 Greenwood Rd, Shreveport, LA 71119. The listed phone number is (318) 562-6320.

What is Jacob Funderburk's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

When was this NPI record last updated?

The NPPES record for Jacob Funderburk was last updated on November 6, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.