Active NPI
Kathleen Dixon Funderburk, LPC, LMFT, LAC, BAS,
- Professional Counselor
- New Iberia, LA
National Provider Identifier
1356608590
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2680
- Practice address
- 432 Hacker St
New Iberia, LA 70560-4564 - Phone
- (337) 303-3777
- NPI assigned
- Apr 12, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 977 | LA | |
| Mental Health Counselor | 101YM0800X | 88572 | NC | |
| Professional Counselor | 101YP2500X | 2680 | LA | Primary |
| Marriage & Family Therapist | 106H00000X | 704 | LA |
Addresses
Primary practice location
432 Hacker St
New Iberia, LA 70560-4564
Mailing address
432 Hacker St
New Iberia, LA 70560-4564
Phone (337) 364-4644
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 704 | Other | LA | LICENSED MARRIAGE AND FAMILY THERAPIST |
| 88572 | Other | NC | NATIONALLY CERTIFIED COUNSELOR |
| 977 | Other | LA | LICENSED ADDICTION COUNSELOR |
| S2680 | Other | LA | BOARD APPROVED SUPERVISOR FOR COUNSELOR INTERNS |
| 2680 | Other | LA | LICENSED PROFESSIONAL COUNSELOR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 977 | LA | MD | Addiction (Substance Use Disorder) Counselor |
| 88572 | NC | MD | Mental Health Counselor |
| 2680 | LA | MD | Professional Counselor |
| 704 | LA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1334188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1334188800000",
"number": "1356608590",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "432 HACKER ST",
"city": "NEW IBERIA",
"state": "LA",
"postal_code": "705604564",
"telephone_number": "337-364-4644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "432 HACKER ST",
"city": "NEW IBERIA",
"state": "LA",
"postal_code": "705604564",
"telephone_number": "337-303-3777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUNDERBURK",
"first_name": "KATHLEEN",
"middle_name": "DIXON",
"credential": "LPC, LMFT, LAC, BAS,",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-04-12",
"last_updated": "2012-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "LA",
"license": "977",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "88572",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "LA",
"license": "2680",
"primary": true
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "LA",
"license": "704",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSED MARRIAGE AND FAMILY THERAPIST",
"identifier": "704",
"state": "LA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONALLY CERTIFIED COUNSELOR",
"identifier": "88572",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSED ADDICTION COUNSELOR",
"identifier": "977",
"state": "LA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD APPROVED SUPERVISOR FOR COUNSELOR INTERNS",
"identifier": "S2680",
"state": "LA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSED PROFESSIONAL COUNSELOR",
"identifier": "2680",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in New Iberia, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.