Active NPI
James E. Fundark, LPCC
- Counselor
- Farmington, NM
National Provider Identifier
1891942942
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 0101791
- Practice address
- 4500 Wildflower Dr
Farmington, NM 87401-2825 - Phone
- (505) 325-2008
- NPI assigned
- Aug 20, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 0101791 | NM | Primary |
Addresses
Primary practice location
4500 Wildflower Dr
Farmington, NM 87401-2825
Mailing address
2905 Yale Dr
Farmington, NM 87402-4548
Phone (505) 793-2917
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 |
|---|---|---|---|
| 0101791 | NM | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219276800000",
"number": "1891942942",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2905 YALE DR",
"city": "FARMINGTON",
"state": "NM",
"postal_code": "874024548",
"telephone_number": "505-793-2917"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 WILDFLOWER DR",
"city": "FARMINGTON",
"state": "NM",
"postal_code": "874012825",
"telephone_number": "505-325-2008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUNDARK",
"first_name": "JAMES",
"middle_name": "E.",
"name_prefix": "Mr.",
"credential": "LPCC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-08-20",
"last_updated": "2008-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NM",
"license": "0101791",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Farmington, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.