Provider Demographics
NPI:1093602542
Name:FUNDERBURK, BERNARD III
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:
Last Name:FUNDERBURK
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 W 40TH AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-5059
Mailing Address - Country:US
Mailing Address - Phone:720-387-1575
Mailing Address - Fax:
Practice Address - Street 1:8805 W 14TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-4850
Practice Address - Country:US
Practice Address - Phone:720-414-1456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician