Healthcare Provider Details

I. General information

NPI: 1629289640
Provider Name (Legal Business Name): STEVEN CHARLES YUND M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29484 HOLLY ST NW
ISANTI MN
55040-8032
US

IV. Provider business mailing address

29484 HOLLY ST NW
ISANTI MN
55040-8032
US

V. Phone/Fax

Practice location:
  • Phone: 763-444-6579
  • Fax:
Mailing address:
  • Phone: 763-444-6579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number3162
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: