Healthcare Provider Details

I. General information

NPI: 1114104163
Provider Name (Legal Business Name): WILLIAM S LUNDGREN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 GRAND SUITE 304
DENVER CO
80203
US

IV. Provider business mailing address

1365 COLUMBINE #104
DENVER CO
80206
US

V. Phone/Fax

Practice location:
  • Phone: 303-329-2928
  • Fax: 303-329-2917
Mailing address:
  • Phone: 303-329-2928
  • Fax: 303-329-2917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3169
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS006144L
License Number StatePA

VIII. Authorized Official

Name: MR. WILLIAM S LUNDGREN
Title or Position: OWNER
Credential: LPC CAC III CEAP
Phone: 303-329-2928