MEDICARE: JEFFREY ALVIN LUNDGREN CMHC

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
1	101YM0800X	Mental Health Counselor	11805165-6004	UT

General Provider Information

NPI Number	:	1437711611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY ALVIN LUNDGREN CMHC

Provider Business Mailing Address
First Line	:	1371 E 1700 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-3745
Country	:	US
Telephone Number	:	303-810-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	4055 S 700 E STE 103
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84107-2508
Country	:	US
Telephone Number	:	801-874-2679
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2019
Last Update Date	:	02/20/2024

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