Provider Demographics
NPI:1194326462
Name:FUNDERBURK PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:FUNDERBURK PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITTNI
Authorized Official - Middle Name:A
Authorized Official - Last Name:FUNDERBURK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:406-799-1366
Mailing Address - Street 1:15 CARNEGIE DR STE D
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2579
Mailing Address - Country:US
Mailing Address - Phone:406-799-1366
Mailing Address - Fax:
Practice Address - Street 1:38 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3975
Practice Address - Country:US
Practice Address - Phone:406-799-1366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health