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NPI Code Detail

MEDICARE: LARA KRISTINE FUNDABURG BCABA

MEDICARE: LARA KRISTINE FUNDABURG BCABA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106E00000XAssistant Behavior Analyst

General Provider Information

NPI Number : 1104217967
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARA KRISTINE FUNDABURG BCABA
Provider Business Mailing Address
First Line : 6394 COLLEGE BLVD
Second Line :
City : OVERLAND PARK
State : KS
Zip : 66211-1506
Country : US
Telephone Number : 800-345-0448
Fax Number :
Provider Business Practice Location Address
First Line : 214 FERREL ST
Second Line :
City : PLATTE CITY
State : MO
Zip : 64079-9511
Country : US
Telephone Number : 816-469-5162
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2015
Last Update Date : 12/23/2024

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Directions to “ LARA KRISTINE FUNDABURG BCABA” Practice Location

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