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1639749617
JACOB WADE FUNDERBURK
SHREVEPORT, LA
NPI
1639749617
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YP2500X Counselor, Professional
(Licence: LA 8671)
Enumeration Date
2021-06-30
Last Update Date
2024-11-06
Business Address
JACOB WADE FUNDERBURK PLPC
6240 GREENWOOD RD
SHREVEPORT, LA 71119-8413
Phone number: 318-562-6320
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Mailing Address
JACOB WADE FUNDERBURK PLPC
652 PROSPECT ST
SHREVEPORT, LA 71104-3124
Phone number: 318-508-1301
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